Free flap reconstruction of oral composite defect complicated by intraoperative cardiac arrest: a case report

We report the case of intraoperative cardiac arrest of a patient undergoing free tissue harvest for an oral composite defect and subsequent completion of reconstruction with simultaneous double flaps. A 54-year-old man with advanced carcinoma of the tongue underwent near-total glossectomy, segmental mandiblectomy, and bilateral neck dissections. We planned a fasciocutaneous anterolateral thigh flap to reconstruct the glossectomy defect, and a fibula osteocutaneous flap for the mandible defect. After the fibula flap harvest, the patient suffered a cardiac arrest. After a 4-min code, the patient regained a sinus rhythm and became hemodynamically stable. We completed the cancer resection and banked the pedicled, osteotomized fibula flap in the lower extremity. We took the patient back to the operating room on postoperative day number 5 for successful reconstruction with simultaneous fibula and ALF flaps. The microvascular surgeon must always be poised to rapidly address intraoperative complications that may critically compromise the success of the free flap or, more seriously, jeopardize the patient's life.