history of present illness: the patient is a 47 year old male with a history of oral cancer status post partial glossectomy in and , who was admitted on , for recurrent right oropharyngeal tumor with extension to the floor of the mouth and the neck. the patient underwent right composite resection with segmental vestibulectomy, rlt hemiglossectomy, and pectoral flap reconstruction of the floor of the mouth and neck. after surgery the patient was transferred to the intensive care unit, intubated, on antibiotics, cefazolin and flagyl, and on intravenous fluids. bilateral lower extremity venous ultrasounds were obtained to rule out deep venous thrombosis because the venodyne were off in the operating room. ultrasound was negative for deep venous thrombosis. hospital course: on postoperative day one, tube feeds were started and the next day, the patient was weaned off the ventilator and under sedation. on postoperative day three, speech and swallow was consulted and a passy-muir valve was placed. on postoperative day five, the patient was transferred to the floor and was able to ambulate, however, by postoperative day seven, the patient's course was complicated by tongue ischemia and dehiscence of the flap along the midline of the throat with fistula formation. the next day, the patient was taken to the operating room for washout and closure but subsequently needed additional debridement on postoperative day ten. in the operating room, the patient also received a j-tube for continuation of his tube feeds secondary to concerns of malnutrition, with an albumin of 2.9. the next day, postoperative day eleven, the patient's tube feeds were restarted and his antibiotics were changed to levofloxacin 500 mg q. day from ancef based on cultures growing methicillin sensitive staphylococcus aureus, beta strep and serratia marcescens, pan sensitive. on postoperative day thirteen, the patient was taken back to the operating room for a free rectus myocutaneous free flap for reconstruction of the floor of the mouth. after surgery, the patient was transferred to the surgical intensive care unit and the next day, he was weaned off the ventilator and on postoperative day fifteen, he was transferred to the floor in stable condition on the plastics service. postoperative day seventeen, the patient was able to ambulate, tolerated tube feeds. his trache was changed to a #6 cuffless shiley. postoperative day eighteen, the patient was discharged home with services. condition at discharge: stable. discharge diagnoses: 1. resection of oral cavity tumor. 2. reconstruction using back flap and rectus flap for the floor of the mouth. discharge medications: 1. normal saline injection. 2. tube feed with promod with fiber, one p.o. once a day; goal is 120 cc an hour given over 16 hours. 3. levofloxacin 500 mg once a day. 4. metronidazole 500 mg q. eight hours. 5. fentanyl patch 50 micrograms q. 72 hours. 6. aspirin 81 mg. 7. metoprolol succinate 25 mg q. 24 hours. 8. chlorhexadol gluconate 1.2 mg. 9. metoclopramide. 10. zolpidem. 11. roxicet 5/325, in 5 ml solution. discharge instructions: 1. the patient was also discharged with services. 2. the patient was instructed to arrange an appointment with dr. and with dr. . , m.d. dictated by: medquist36 Procedure: Continuous invasive mechanical ventilation for 96 consecutive hours or more Reconstruction of eyelid with hair follicle graft Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue Laryngoscopy and other tracheoscopy Laryngoscopy and other tracheoscopy Temporary tracheostomy Other skin graft to lip and mouth Other reconstruction of mandible Other reconstruction of mandible Partial glossectomy Other excision of vessels, other vessels of head and neck Other excision of mouth Partial mandibulectomy Closed [needle] biopsy of tongue Biopsy of mouth, unspecified structure Diagnoses: Chronic airway obstruction, not elsewhere classified Secondary malignant neoplasm of other specified sites Personal history of tobacco use Secondary malignant neoplasm of bone and bone marrow Disruption of external operation (surgical) wound Glossitis Persistent postoperative fistula Malignant neoplasm of floor of mouth, part unspecified