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Microvascular Free Tissue Transfer in Organ Transplantation Patients: Is It Safe?

Lee, Anh B. M.D.; Dupin, Charles L. M.D.; Colen, Lawrence M.D.; Jones, Neil F. M.D.; May, James W. M.D.; Chiu, Ernest S. M.D.

Plastic & Reconstructive Surgery: June 2008 - Volume 121 - Issue 6 - pp 1986-1992
doi: 10.1097/PRS.0b013e31817123b0
Reconstructive: Trunk: Original Articles

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.

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.

Received for publication February 12, 2007; accepted April 16, 2007.

Presented at Plastic Surgery 2006: The 75th Annual Meeting of the American Society of Plastic Surgeons Meeting, in San Francisco, California, October 6 through 11, 2006.

Disclosure: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this article.

Ernest S. Chiu, M.D., Division of Plastic and Reconstructive Surgery, Tulane Health Sciences Center, 1430 Tulane Avenue, SL-22, New Orleans, La. 70112, eschiu@tulane.edu

©2008American Society of Plastic Surgeons