Vascularized Free Tissue Transfer in a Patient with Hemophilia B: Case Report and Literature Review
Table 2
The recommended perioperative protocol established by the hematology department for ablation of a mandibular tumor with free fibular flap reconstruction.
(i) Infuse 100 units/kg (100%) Mononine 15-30 minutes prior to the procedure through peripheral vein access. Start Amicar 6 g every 6 hours for 5 days
(ii) Obtain factor IX assay and aPTT 30 minutes postinitial infusion (do not wait for level to come back to begin surgery). This should be drawn with a peripheral stick. Do not draw through a heparinized IV
(iv) For subjectively increased bleeding during surgery and a prolonged aPTT, infuse 100/units/kg Mononine as needed
(v) Infuse 25 units/kg (25%) Mononine 12 hours after the 2nd dose and then 25 units/kg every 12 hours while admitted
(vi) Obtain factor IX assay trough prior to 3rd dose then as needed while admitted to maintain through to the 14th postoperative day. This should be drawn with a peripheral stick. Do not draw through a heparinized IV. If , give 100 units/kg Mononine and then continue 25 units/kg every 12 hours
(vii) Discharge the patient with peripheral IV in place so that he can administer factor at home
Home schedule:
(viii) Infuse 100 units/kg (100%) Mononine once every 24 hours until postoperative day 14, and then infuse 25 units/kg Mononine every 24 hours until postoperative 21
(ix) Follow up with the bleeding disorders clinic one week after discharge
