Pulmonary Atelectasis After Reconstruction With a Rectus Abdominis Free Tissue Transfer

Abstract

Background: Atelectasis is one of the most common postoperative complications encountered in head and neck surgery. Risk factors include preexisting pulmonary disease, the procedure performed, and the length of anesthetic. Regional flaps used to reconstruct defects in the head and neck predispose to radiographic atelectasis. The rectus abdominis myocutaneous flap is usually transferred as a free tissue transfer. Harvesting the flap results in abdominal wall pain and postoperative splinting that may contribute to an increased development of atelectasis. To our knowledge, this issue has not been previously examined.

Predictive Factors of Atelectasis Following Endoscopic Resection

“…Atelectasis can occur following non-surgical procedure under deep sedation, such as endoscopic resection. However, previous studies have focused on perioperative atelectasis performed under general anesthesia [11][12][13][14]. Few focused on endoscopic procedures performed under deep sedation.…”

Atelectasis after free rectus transfer and abdominal wall reconstruction

“…Previously, the pectoralis major myocutaneous flap was considered to be the “workhorse” flap for reconstruction of head and neck soft tissue defects 3–6. However, the increasing use of free tissue transfer has allowed for more precise replacement of composite defects with like composite tissue.…”

“…Wax et al3 studied 53 patients undergoing rectus abdominis myocutaneous free tissue transfer. The average skin paddle size was 120 cm 2 .…”

“…Severe atelectasis can result in shunting of pulmonary blood flow across unventilated alveoli resulting in hypoxemia. By radiographic criteria, postoperative atelectasis has been detected in 20% to 83% of patients with major atelectasis occurring in 1% to 25% 3–6…”

“…Although primary fascial closure can be achieved, this can potentially result in abdominal wall tightness. This, combined with splinting resulting from incisional pain, may contribute to a higher incidence of atelectasis 3. With this in mind, we have been augmenting the abdominal wall fascial defect with commercial acellular dermis or surgical mesh (Figure 1).…”