Patient History

A 30-year-old female with Hemophilia A, mild disease (Factor VIII, 7%), was admitted for left oronasal fistula repair because of increasing problems with nasal regurgitation of food and nasal speech. During the past year, the patient had a series of facial reconstruction surgeries following severe facial trauma to the left maxilla following a motor vehicle accident. The patient was initially stable following her latest surgery with radial forearm flap repair, however developed significant bleeding and a hematoma beneath the facial flap. The patient was returned to the operating room where hemostasis was achieved with electrocautery and the hematoma was successfully evacuated. The patient received treatment with Factor VIII infusions and was moved to the intensive care unit, pharmacologically sedated and paralyzed, and intubated. This radial forearm facial flap failed, and required surgical revision. Further complications ensued, requiring surgical evacuation of a recurrent hematoma, and broad-coverage antibiotic therapy for nosocomial pneumonia. The patient remained intubated, sedated, and paralyzed with continued bleeding refractory to Factor VIII infusions.