We report two cases of central venous catheter-related deep venous thrombosis (DVT) that occurred after oral cancer resection and reconstruction with vascularized free flap. In addition, we present a manual on coping with DVT which has been used by dentists in the Hokkaido University Hospital since July 2014.
First case: A 60-year-old man with oral floor cancer (cT4aN1M0) underwent tumor resection, neck dissection, and reconstruction with anterolateral thigh flap in May 2010. At the time of administration of general anesthesia, a central venous catheter (CVC) was inserted through the femoral vein and it was removed five days after the operation. In April, prior to the operation, early gastric cancer was detected endoscopically. Three months after the operation, enhanced CT was performed before endoscopic submucosal dissection for the gastric cancer. A 7-cm thrombus was detected in the inferior vena cava, which was diagnosed as deep venous thrombosis (DVT). Warfarin was administered as an anticoagulant. Two weeks later, the size of the thrombus decreased, and it disappeared after two more months of warfarin therapy.
Second case: A 69-year-old woman with tongue cancer (cT2N0M0) underwent tongue resection, neck dissection, and reconstruction with anterolateral thigh flap in February 2014. At the time of administration of general anesthesia, a CVC was inserted through the femoral vein; it was removed seven days after the operation. Drug-induced hepatopathy related to prostaglandin E1 occurred one week after the operation. Ultrasonography revealed DVT. Heparin was immediately administered intravenously as an anticoagulant. The thrombus disappeared after heparin therapy for a week.

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Negative pressure wound therapy has recently been cited as one of the most important adjunctive therapies for wound treatment, but reports of its use in the oral and maxillofacial region are rare. We report a case involving the use of negative pressure wound therapy in oral cancer.
A non-healing fistula developed after rectus abdominis musculocutaneous flap reconstruction surgery associated with locally advanced tongue cancer resection. Healing was achieved using negative pressure wound therapy. No evidence of recurrence or metastasis was noted 32 months postoperatively.

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Kaposi’s sarcoma (KS) is a malignant tumor and is one of the major complications of patients with AIDS, but is rare in Japan. We report a case of AIDS-associated multiple KS of the oral region on the basis of clinical and pathological findings. The patient was a 32-year-old male who had been suffering from a gingival neoplasm-like mass of the incisor region of the maxilla. Intraoral findings showed multiple lesions in this patient. He was diagnosed with AIDS based on data of HIV-RNA: 180,000 copies/ml and CD4: 27/μl. Therefore, the patient’s oral lesion was suspected to be oral KS. A histopathological examination of a gingival biopsy specimen showed typical findings of KS. Furthermore, we confirmed the presence of human herpesvirus (HHV)-8 in this case by immunohistochemistry. Combination anti-retroviral therapy (ART) and liposomal doxorubicin was administered and the patient achieved complete remission (CR) for 3 years.

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