Abstract
von Willebrand disease （vWD） is a hypothrombotic dysfunction caused by a quantitative decrease or qualitative abnormalities in von Willebrand factor （vWF） and may hinder hemostasis during surgery. We report the safe achievement of hemostasis during reconstructive surgery for lower gingival carcinoma in a patient with vWD by clotting factor replacement therapy. The patient was a 63-year-old man. He had been diagnosed with vWD when treated for lung cancer in the past. At the first visit to our department, vWF ristocetin cofactor activity （vWF: RCo） was less than 6％, vWF antigen quantification （vWF: Ag） was 26％, and factor Ⅷ activity （FⅧ: C） was 75.1％. Reconstructive surgery was planned after induction chemotherapy for right mandibular gingival squamous cell carcinoma （T4bN2bM0）. Freeze-dried concentrated human blood-coagulation factor Ⅷ 2000 unit/body was administered from 2 days before surgery. On the day before surgery, vWF: RCo increased to 158％, vWF: Ag to 275％, and FⅧ: C to 110％. We performed neck dissection, mandibular segment resection, and reconstruction by a titanium plate and rectus abdominis flap with good hemostasis, and there was no postoperative bleeding.
