Microvascular free tissue transfer in organ transplantation patients: is it safe?
BACKGROUND
Traditionally, organ transplantation has been synonymous with patients with poor prognosis and outcome. Surgeons felt that the risks posed by immunosuppressive drugs outweighed the benefits of non-life-threatening procedures. With the enormous advances in the field of organ transplantation, a growing number of transplant patients present for a variety of surgical procedures. The objective of this report was to study the surgical outcome of organ transplantation patients who required reconstructive surgery using free tissue transfer.


METHODS
A multicenter retrospective study was conducted on organ transplant patients who underwent elective microvascular free flap procedures. Patient chart review included cause of organ failure, medications, reconstruction site, flap choice, days hospitalized, complications, and outcome.


RESULTS
Five independent medical centers participated in the study. Nineteen organ transplant patients required free flaps. Free flaps were used to reconstruct a variety of surgical defects, including breast, head and neck, and upper and lower extremities. There were no flap losses. Flaps used included musculocutaneous (n = 13), fasciocutaneous (n = 5), and osteocutaneous (n = 1) free flaps. Hospital length of stay ranged from 3 to 17 days. Complications included loss of skin graft, suture line dehiscence, and hematoma formation. Delayed wound healing was observed in two patients.


CONCLUSIONS
In the properly selected patient, microvascular free tissue transfer can be performed safely and with acceptable surgical outcome. Contrary to popular belief, delayed wound healing from immunosuppressive agents was uncommon. Free tissue transfer in healthy organ transplant patients can be considered in reconstructive surgery decision making.
Lee
Anh B
AB
New Orleans, La.; Norfolk, Va.; Los Angeles, Calif.; and Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Tulane Health Sciences Center, Louisiana State University Health Sciences Center, Eastern Virginia Medical School, University of California, Los Angeles Medical Center, and Harvard Medical School.
Dupin
Charles L
CL
Colen
Lawrence
L
Jones
Neil F
NF
May
James W
JW
Chiu
Ernest S
ES
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016377:Organ Transplantation; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology