• Dong Yun Lee, SooA Lim, SuRak Eo, and Jung Soo Yoon.
• Department of Plastic and Reconstructive Surgery, DongGuk University Medical Center, GoYang, South Korea.
• Medicine (Baltimore). 2023 Sep 8; 102 (36): e35097e35097.

RationaleReconstruction of wound complications in patients with advanced cancer with distant metastases is challenging for plastic surgeons. This may be due to the cancer patients' hypercoagulability and potential intolerance to general anesthesia. This article aimed to discuss the risk of free-flap reconstruction in such cases.Patient ConcernsThe patient was a 58-year-old female with advanced non-small cell lung cancer and brain metastasis. The patient underwent brain radiotherapy and chemotherapy through the Ommaya Reservoir.DiagnosesA year ago, she underwent several local flap closures for recurrent wound healing failure due to wound complications, including infection, wound dehiscence, and subsequent device removal.InterventionsA radial forearm free flap was created under general anesthesia. The patient was discharged in the third postoperative week since the flap remained stable.OutcomesAt follow-up a month thereafter, the patient exhibited signs of recovery without any complications even while continuing her chemotherapeutic regimen.LessonsFree flap placement is not an absolute contraindication in cancer patients with distant metastases. Nevertheless, it is associated with clinical challenges and operator hesitancy. This is a case of a successful free flap in a cancer patient with hypercoagulability and suspected floating tumor cells. Postoperative management, in this case, is appropriate.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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