Perioperative Strategies to Reduce Occupational HIV Exposure in Head and Neck Microsurgical Reconstruction: A Case Report

Complex head and neck reconstructive surgeries in patients living with human immunodeficiency virus (HIV) present unique risks of occupational bloodborne pathogen exposure. We report the case of a 63-year-old man with well-controlled, long-standing HIV infection who underwent hemiglossectomy and microvascular free flap reconstruction for advanced tongue cancer. He was receiving antiretroviral therapy and had a CD4⁺ T-cell count of 361 cells/µL-above the threshold for acquired immunodeficiency syndrome (AIDS)-consistent with partial immune recovery. To minimize occupational exposure risk, we implemented a structured, procedure-specific exposure reduction bundle tailored to intraoral surgery. This included instrument-only suturing facilitated by an intraoral mouth opener, extended-length needle holders to increase working distance from the patient's dentition, a predefined hands-free neutral zone with a designated needle parking area for instrument exchange, and readiness to initiate post-exposure prophylaxis. An anterolateral thigh free flap was harvested and inset without intraoperative complications. Notably, no occupational exposures occurred. The flap remained viable, and the patient was discharged on postoperative day 35. This framework may serve as a practical reference for surgical teams managing similar high-risk intraoral procedures in patients with HIV.