Internal jugular vein thrombosis after microvascular head and neck reconstruction in a hemodynamically unstable patient.

Several studies have reported on the incidence, risk factors, and clinical presentation of internal jugular vein thrombosis (IJVT). The impact of IJVT could be critical in patients who undergo microvascular head and neck reconstruction. In our current study, a case of IJVT following free flap soft palate reconstruction is presented, in which 2 veins of radial forearm flap were draining into the IJV with a blind cephalic end. Thrombosis occurred at the sixth postoperative day when the patient's hemodynamic status changed after discontinuation of cardiac inotropics and vasopressors. The pathophysiology as well as the clinical significance of IJVT for microvascular head and neck reconstruction is discussed with focus on the selection of the recipient vein in free flap surgery.