Abstract:

To summarize the nursing experience of a patient with oral multiple primary tumors who developed flap vascular crisis，wound bleeding，pulmonary embolism，and tracheal softening collapse following free flap transplantation. The nursing challenges in this case included the superimposed multiple complications，contradiction between anticoagulation and bleeding，pulmonary embolism and pulmonary infection lead to decreased ventilation function，increased airway pressure，and induced tracheomalacia. We implemented multi-dimensional precise monitoring and early warning for vascular crisis of skin flaps，dynamic balance management of anticoagulation and hemostasis to break the chain reaction of complications，stepwise intervention for tracheal softening collapse to establish an airway safety protection system，and precision control of multi-drug resistant infections to break the vicious cycle. The patient was discharged with T-shaped silicone tube after 66 days of hospitalization and followed up for 2 month with good recovery.

Key words: Neoplasms, Multiple Primary, Free Flap Transplantation, Vascular Crisis, Laryngomalacia, Critical Care Nursing