Free tissue transfer in solid organ transplant patients

Objectives: Patients with head and neck malignancies who have had solid organ transplant and require free tissue transfer are a unique population Immunosuppression affects wound healing through inhibition of inflammatory mediators This study was performed to evaluate the effect of immunosuppression on the rate of perioperative complications and the success of free tissue transfer in the head and neck Study Design: Retrospective chart review Methods: Retrospective chart review was performed at two academic institutions Solid organ transplant patients undergoing free tissue transfer for head and neck malignancies from 1998 2010 were included Complications analyzed included: flap failure, partial flap necrosis, wound infection, donor or recipient site complications, hematoma, and seroma Results: A total of 22 flaps in 17 patients were performed Solid organ transplantations were kidney (11/17), liver (4/17), heart (2/17), and lung (1/17) Eight patients (11/22 flaps) had complications, including: wound infection (3/22), hematoma (3/22), flap failure (1/21), partial flap necrosis (1/22), donor site dehiscence (1/22), donor site tendon exposure (1/22), and seroma (1/22) The median hospital stay was 6 days (range, 4 26 days) The median length of follow up was 13.5 months (range, 3.5 49.9 months) Survival was 29% at the time of last follow up Conclusions: Solid organ transplant patients are at an increased risk of de novo malignancies due to chronic immunosuppression These patients will occasionally require free tissue transfer for coverage of large defects of the head and neck This study demonstrates that free tissue transfer is a viable option in transplant patients with failure rates similar to nontransplant patients.