A review of 32 free flaps in patients with collagen vascular disorders

Collagen vascular diseases affect multiple organs by the deposition of immunoglobulins along vascular basement membranes. This pathophysiology potentially makes these patients poor free flap candidates, with a possible increased risk of failure. The often concomitant finding of hypercoagulability may also compound the risk.

A retrospective review was conducted of all free flap reconstructions performed between 2005 and 2009. Of a total of 1251 flaps, 25 patients, who underwent 32 flaps, were identified with connective tissue disorders. These included Sjögren syndrome, Raynaud phenomenon, rheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, scleroderma, and multicentric thrombocytosis.

The mean age of the patients was 51 years, and the average body mass index was 28.1 kg/m(2). Seven patients were on chronic immunosuppression. Flap reconstructions included seven deep inferior epigastric perforator flaps, 21 transverse rectus abdominis musculocutaneous flaps, one gluteal flap for breast reconstruction, and one anterolateral thigh and two radial forearm flaps for head and neck reconstruction. All flaps were performed with a single arterial and venous anastomosis. None had microvascular flap complications. There was one case of postoperative deep vein thrombosis. There were three cases of wound dehiscence and one case of ventral hernia.

Blood vessels and soft tissues are injured by inflammation as the primary target of collagen vascular diseases. The increased incidence for thrombotic events deems them potentially high-risk free tissue transfer patients. The authors demonstrate from their series, however, that there is no increased risk of thrombosis, and this patient population should not be precluded from free flap reconstruction.

Risk, IV.