The objective of this report was to study the surgical outcome of organ transplantation patients who required reconstructive surgery using free tissue transfer. A retrospective study of five independent medical centers was conducted on organ transplant patients who underwent elective microvascular free flap procedures.
Nineteen organ transplant patients required free flaps to reconstruct 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. The incidence of postoperative complications after microvascular free flap surgery in organ transplant recipient patients were found to be similar to healthy patients. The authors conclude that in the properly selected patient, microvascular free tissue transfer can be performed safely and with acceptable surgical outcome.
Transplantation is the accepted standard of care for many with end-stage organ failure. With advances in immunosuppression and surgical technique patients are afforded the opportunity of improved quality of life and longevity. Yet, there is hesitancy to advocate elective microsurgery for this patient population due to concomitant medical comorbidities, wound healing liabilities of chronic immunosuppression, and potential for increased microvascular thrombosis. Prior to this article, there have only been isolated cases reports of successful free tissue transfer in the setting of organ transplantation. This larger case series indicates that contrary to popular belief, chronic immunosuppressive therapy does not have an adverse effect on flap survival, organ graft survival, or wound healing; and demonstrates the safety of microvascular free flap procedures in carefully selected organ transplantation patients.