title: The effects of immunosuppressive medications on outcomes in microvascular free tissue transfer.
abstract: BACKGROUND
  Reported 10-year patient survival after liver transplantation is nearing 70 percent, with similar trends seen for kidney transplantation. With increasing life expectancy, these patients have an increased need for posttransplant reconstructive surgery. Thus, plastic surgeons must know the effects of immunosuppressive medications on outcomes in microvascular reconstruction.
  
  
  METHODS
  A retrospective review was performed on all immunosuppressed solid-organ transplant patients who underwent subsequent free tissue transfer of all types, over an 8-year period. Patient demographics, type of solid organ transplant, immunosuppressive regimen, anticoagulation regimen, associated medical comorbidities, and complication rates were analyzed.
  
  
  RESULTS
  Twenty-four microvascular free tissue transfers were performed over an 8-year period on immunosuppressed patients, for head and neck and lower extremity reconstruction. Fifteen patients (63 percent) underwent prior kidney transplant, seven (29 percent) underwent prior liver transplant, and two (8 percent) underwent prior lung transplant. Prednisone (79 percent of patients), cyclosporine (33 percent), and tacrolimus (33 percent) were the most commonly used immunosuppressive medications. Complications included one total flap loss (4 percent), three intraoperative arterial thromboses (13 percent), and two postoperative venous thromboses (8 percent). Univariate analysis illustrated a statistically significant association between prednisone and overall complication rate (p = 0.032).
  
  
  CONCLUSIONS
  Microvascular free tissue transfer is a challenge in immunosuppressed patients. Univariate analysis showed prednisone to correlate statistically with operative morbidity. Transplant patients receiving prednisone at the time of their elective free flap procedure will require additional care to lower the additional risk of delayed wound healing, partial flap loss, and anastomotic thrombosis.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: San Francisco, Calif. From the University of California, San Francisco.
authors.forename: Hani
authors.initials: H
authors.lastname: Sbitany
authors.forename: Xiaoti
authors.initials: X
authors.lastname: Xu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hansen
authors.forename: David M
authors.initials: DM
authors.lastname: Young
authors.forename: William Y
authors.initials: WY
authors.lastname: Hoffman
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D003920:Diabetes Mellitus; D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D016040:Lung Transplantation; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011241:Prednisone / Q000494:pharmacology / Q000627:therapeutic use; D019651:Plastic Surgery Procedures; D012535:Scalp / Q000601:surgery*; D000077195:Squamous Cell Carcinoma of Head and Neck; D014945:Wound Healing / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D011241:Prednisone