The Effects of Immunosuppressive Medications on Outcomes in Microvascular Free Tissue Transfer

Abstract

Therapeutic IV.

Outcomes of microvascular flap reconstruction of the head and neck in patients receiving systemic immunosuppressive therapy for organ transplantation

“…Miller et al reported outcomes in 17 patients that received 22 flaps, all for head and neck reconstruction, with one total flap loss in their series . Sbitany et al evaluated outcomes in 24 patients that underwent free flap reconstruction, predominantly of the lower extremity, and reported one total flap loss; univariate analysis demonstrated significant association between prednisolone and overall complication rate . Our study supports this finding, demonstrating a borderline significant association also between prednisolone and the occurrence of any complication.…”

“…Chronic kidney disease, in particular when associated with related conditions including diabetes mellitus and peripheral vascular disease, increases the risk of reconstructive failure . In addition there are direct surgical risks from the effects of the immunosuppressive agents, in particular corticosteroids, on the inflammatory cascade and cellular responses to infection, including delayed wound healing and infection . Sirolimus, a commonly used immunosuppressive agent is associated with an increased rate of wound‐related complications as well as arterial and venous thrombotic events …”

“…Wound healing requires activation of the inflammatory cascade, which is inhibited by immunosuppressive agents, as well as by many of the concurrent medical comorbidities. Prednisolone is associated with complications in patients with organ transplants undergoing free flap reconstruction . Sirolimus, another commonly used agent, is associated clinically with an increased rate of wound‐related complications and arterial and venous thrombotic events .…”

“…Prednisolone is associated with complications in patients with organ transplants undergoing free flap reconstruction. 9 Sirolimus, another commonly used agent, is associated clinically with an increased rate of wound-related complications and arterial and venous thrombotic events. [10][11][12][13] Although the outcomes of free flap reconstruction in organ transplant patients receiving immunosuppression has been previously reported, there is a paucity of outcome studies concerning the head and neck population where major surgeries are often required.…”

Microsurgical reconstruction of the head and neck region: Current concepts of maxillofacial surgery units worldwide

“…Furthermore, the application of steroids may impede swelling but at the same time it can also inhibit immune competence and thus favor tumor spread. In addition, Sbitany et al (2014) found an increased risk of delayed wound healing, partial flap loss, and anastomotic thrombosis in patients with immunosuppressive medications receiving microvascular free tissue transfer. All these similarities in reconstructive microvascular procedures must not hide the fact that access to this technique is far from being standard worldwide.…”