Postoperative massive hemorrhage in oral cancer surgery nursing interventions and outcomes: A case report.

Abstract

Background: Post-operative massive hemorrhage is a critical concern in oral cancer surgery, associated with severe complications and heightened morbidity and mortality rates.

Case summary: A 46-year-old male with advanced poorly differentiated squamous cell carcinoma (ypT4aN3bN0M0) of the oral floor underwent extensive surgery, including total glossectomy, partial mandibulectomy, and free flap reconstruction. Postoperatively, he developed life-threatening hemorrhage on day 3 due to wound dehiscence. Rapid nursing interventions-prompt suture removal, pressure hemostasis, and multidisciplinary collaboration-controlled bleeding. Postoperative care emphasized hemodynamic monitoring, infection prevention, and rehabilitation. Despite comorbidities (hypertension, diabetes, prior stroke), the patient achieved functional recovery: Oral flap epithelialization, restored swallowing (water swallow test: Grade 1), 70% tongue mobility, and 80% preoperative chewing efficiency at 6-month follow-up. This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.

Conclusion: This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery. By integrating meticulous preoperative risk stratification, intraoperative hemostatic collaboration, and vigilant postoperative monitoring (e.g., timely suture management, pressure hemostasis, blood product administration), the interdisciplinary team achieved rapid hemorrhage control. Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery, enabling the patient to regain swallowing, speech, and mobility despite advanced disease and comorbidities. The findings underscore that standardized nursing workflows, balancing procedural rigor with holistic patient support, are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.