Major surgery can be safely performed in hemophiliacs when adequate factor activity is provided, i.e., 100 percent activity perioperatively and 50 percent activity thereafter. These patients require complete hemostatic evaluation in order to properly titrate perioperative needs. The extreme cost of surgery and hospitalization mandates that, when possible, patients needing multiple procedures have them performed at the same time. A case is presented in which a paraplegic hemophiliac with extensive pressure sores underwent quadruple flaps following these tenets.
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