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Factor V Leiden in Head and Neck Reconstruction: Institutional Experience and Protocol
Adwight Risbud1, Alexander Fish2, Kevin S Scher3
1Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center.
The Journal of Craniofacial Surgery
|July 23, 2026
Summary
Head and neck reconstruction in patients with Factor V Leiden (FVL) mutation is achievable with careful planning. Individualized anticoagulation strategies led to successful outcomes in this high-risk group.
Area of Science:
- Vascular surgery
- Hematology
- Plastic surgery
Background:
- Patients with Factor V Leiden (FVL) mutation have an increased risk of thrombosis, posing challenges for head and neck reconstruction.
- Perioperative management of anticoagulation in this population requires careful consideration to balance bleeding and clotting risks.
Purpose of the Study:
- To report institutional experience with head and neck reconstruction in patients with heterozygous FVL mutation.
- To present a perioperative anticoagulation strategy for this high-risk patient group.
Main Methods:
- Retrospective chart review of patients with confirmed heterozygous FVL mutation undergoing head and neck reconstruction.
- Analysis of patient demographics, reconstructive procedures, anticoagulation regimens, and outcomes.
Main Results:
- Five patients underwent reconstruction (4 microvascular free flaps, 1 regional flap) with successful flap survival.
- One patient developed deep venous thrombosis, successfully managed with anticoagulation; no major bleeding complications occurred.
Conclusions:
- Head and neck reconstruction can be successful in carefully selected FVL mutation patients.
- Multidisciplinary planning and individualized anticoagulation are key.
- Further multi-institutional studies are needed to establish evidence-based guidelines.
