A 19-year-old male patient with type 1 von Willebrand's disease underwent two separate superficial inferior epigastric artery free flap tissue transfers and three revision procedures for reconstruction of a postextirpative mid-facial defect. Intravenous 1-desamino-8-D-arginine vasopressin (DDAVP) was administered as bleeding prophylaxis prior to incision for free tissue transfer. For each debulking procedure, DDAVP was administered by intranasal sprays in minutes prior to incision and redosed 12 and 24 hours postoperatively. There were no incidents of either thrombosis or bleeding. This outcome indicates that 0.3 μg/kg intravenous DDAVP may be effective as bleeding prophylaxis for patients with mild and quantitative defects in von Willebrand factor undergoing microvascular reconstruction.
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