| Summary: | Maxillofacial reconstruction with microvascular free tissue transfer is an effective procedure used to correct facial defects following resection of head and neck cancer. Flap failure is uncommon but can occur due to thrombosis, infection, or hemorrhage, and therefore needs to be addressed immediately. We present a case of a 78-year-old man with squamous cell carcinoma who underwent right cheek resection, orbital exenteration and removal of the superior maxillary sinus with left radial forearm free tissue flap reconstruction which was complicated by infection and recurrent, intractable hemorrhage from an internal maxillary artery pseudoaneurysm. Initial management included multiple cautery and ligation attempts, but bleeding recurred despite these measures. Endovascular intervention proved to be an effective and safe treatment, leading to the resolution of bleeding. This report provides rationale for considering endovascular embolization for cases of bleeding following maxillofacial free flap reconstruction.
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