Microvascular free tissue transfer in patients with hematological disorders

BACKGROUND: Microsurgical procedures performed in patients with hematological disorders can pose significant challenges. The literature is lacking in reports that specifically address the safety, reliability, and management techniques related to performing microvascular surgery in this group of patients. METHODS: A retrospective chart review of all patients with hematological disorders who received free flaps from 1995 to 2004 was performed. All patients had a hematologic work-up that confirmed the stability of the underlying disease. There were three male and three female patients with an average age of 27.6 years (range,12 to 63 years). Patients had leukemia (n = 2), hereditary spherocytosis, non-Hodgkin's lymphoma, and hemophilia (n = 2). Their defects were in the areas of the nasocolumella/upper lip, palate, palate and midface, and lower extremities. RESULTS: All patients received free flaps and all but one had an uneventful postoperative course. That patient, with hemophilia, 1 day after factor replacement was halted, had bleeding that required surgical re-exploration along with aggressive hematologic management. All flaps survived without vascular compromise. No wound infections were observed. All donor sites healed without complications. CONCLUSIONS: Essential ingredients in the treatment plan of patients with hematologic disorders undergoing free flaps include familiarity with the preoperative medical condition and potential postoperative complications, close monitoring of the patients and their medical condition before and after surgery, meticulous surgical technique, and close cooperation with the hematologists and infectious disease specialists. By following this regimen, patients with hematologic disorders and an otherwise stable medical history can undergo free tissue transfer safely and effectively with reliable outcomes.