title: Reconstructive surgery in immunocompromised patients: evaluation and therapy.
abstract: BACKGROUND
  An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures.
  
  
  METHODS
  A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma.
  
  
  RESULTS
  In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment.
  
  
  CONCLUSIONS
  Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a 'less is more' strategy in selected cases.
authors.affiliation: Department of Plastic Surgery and Hand Surgery, St. Marien-Hospital Berlin, Germany; Department of Plastic and Aesthetic Surgery, Hand Surgery, Markus-Hospital Frankfurt, Germany.
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Dunda
authors.affiliation: Department of Plastic and Aesthetic Surgery, Hand Surgery, Markus-Hospital Frankfurt, Germany; Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH University Hospital Aachen, Germany.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Bozkurt
authors.affiliation: Department of Plastic Surgery, Reconstructive and Hand Surgery, Burn Center, RWTH University Hospital Aachen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Pallua
authors.affiliation: Department of Plastic Surgery and Hand Surgery, St. Marien-Hospital Berlin, Germany; Center for Musculoskeletal Surgery, Charité - Medical University of Berlin, Germany.
authors.forename: Björn Dirk
authors.initials: BD
authors.lastname: Krapohl
keywords: immunocompromised patients; plastic surgery; reconstructive surgery