Factor V Leiden in Head and Neck Reconstruction: Institutional Experience and Protocol

OBJECTIVES: To describe our institutional experience with head and neck reconstruction in patients with heterozygous Factor V Leiden (FVL) mutation and present a perioperative anticoagulation strategy utilized in this high-risk population. METHODS: A retrospective chart review was performed of patients with genetically confirmed heterozygous FVL mutation who underwent head and neck reconstruction at a single tertiary academic medical center between 2017 and 2026. Patient demographics, reconstructive procedures, perioperative anticoagulation regimens, and postoperative outcomes were descriptively analyzed. RESULTS: Five patients with heterozygous FVL underwent reconstruction, including 4 microvascular free flaps and 1 regional flap. The median age was 69 years (range: 44-74 y). Reconstructive procedures included 2 fibula free flaps, 2 radial forearm free flaps, and 1 supraclavicular artery island flap. One patient required secondary fibula free flap reconstruction following osteoradionecrosis. All flaps survived without partial or complete flap loss during the index admission. One patient developed postoperative deep venous thrombosis managed successfully with anticoagulation. No hematomas or flap-related hemorrhagic complications occurred. CONCLUSIONS: Successful head and neck reconstruction may be achievable in carefully selected patients with heterozygous FVL mutation using multidisciplinary perioperative planning and individualized anticoagulation strategies. Larger multi-institutional studies are needed to better characterize reconstructive outcomes and establish evidence-based perioperative management guidelines in this patient population.