Pulmonary atelectasis after reconstruction with a latissimus dorsi myocutaneous flap

Atelectasis is the most common postoperative complication encountered in head and neck surgery. Risk factors include preexisting pulmonarydisease, type of surgery performed, and the length of anesthetic. It is controversial whether reconstruction of defects with regional myogenous flaps predisposes to atelectasis. The latissimus dorsi myocutaneous flap requires the patient to be placed on his side for a period of time. Whether it is the position or the surgery that contributesto the development of atelectasis has not been examined.Eighteen patients underwent latissimus dorsi myocutaneous flap reconstruction following major ablative procedures for head and neck cancer. The cutaneous area transferred ranged from 70 to 225 cm² (mean, 128 cm²). The flap size ranged from 7 × 10 to 15 × 15 cm. The majority of flaps were 10 ×15 cm or greater. These patients were comparedto 18 patients who did not undergo pedicled myocutaneous chest flap reconstruction. Patients were matched for age, sex, length of operation, site of primary, and stage of disease.Postoperative atelectasis was radiographically detected in 89% of flap patients vs. 79% of controls. Major atelectasiswas encountered in 16% of patients undergoing flap surgery vs. 11% of patients in the control group. Patients with large cutaneous paddles on their flaps (>120 cm²) had significantly more atelectasis than patients with smaller cutaneous paddles (P <.05, chi-squared).The incidence of radiographic postoperative atelectasis in patients having a latissimus dorsi myocutaneous flap is high. The size of the skin paddle harvested as well as the position change may contribute to this.