Abstract
Background Microsurgical free tissue transfer is a popular technique nowadays. Because of its
considerably exquisite procedure, various risk factors can affect surgical outcome.
However, current key practices, especially those in blood transfusion, are in contention
due to the lack of enough evidence. Therefore, the objective of this study was to
investigate the impact of perioperative blood transfusion on microsurgical complication.
Methods Data of a total of 168 patients who underwent microvascular free tissue transfer
from 2013 through 2016 were retrospectively reviewed. Age, comorbidity, anatomical
surgical site, preoperative and postoperative lowest hemoglobin (Hb) level, estimated
blood volume loss, and final clinical flap outcome were compared between patients
with and without transfusion treatment. Factors with a significance of p < 0.05 in univariate analysis were included in the multivariate logistic regression
model to identify independent risk factors.
Results Of 168 patients, 72 (43%) were in the transfusion group. Cross analysis statistics
showed that flap failure in the transfusion group was 3.6 times higher (p = 0.018) than that in the control group. Multivariable analysis revealed that age
(p = 0.083) and perioperative lowest Hb level (p = 0.021) remained as significant predictors of flap failure. Receiver-operating characteristic
curve analysis showed that the appropriate lower limit of transfusion commencement
of Hb was 8.75 g/dL (area under the curve: 0.721).
Conclusion A transfusion during perioperative period of free flap did not increase its failure
rate. Rather than appropriate transfusion strategy, perioperative lowest Hb level,
and age were significant predictors of flap failure. Therefore, transfusion can be
confidently used in patients who undergo free flap without any hesitation. Results
of this study provide practical evidence of performing perioperative transfusion for
free tissue transfer patients.
Keywords
transfusion - free flap - flap survival - perioperative management - flap reconstruction
