Safety of microvascular free tissue transfer reconstruction of the head and neck in the setting of chronic pharmacologic immunosuppression

Head Neck. 2022 Jul;44(7):1520-1527. doi: 10.1002/hed.27049. Epub 2022 Apr 19.


Background: Patients on chronic pharmacologic immunosuppressive therapy are at increased risk of wound infection and complications after surgery. There is a paucity of data examining perioperative complications after microvascular free tissue transfer (MVFTT) reconstruction of the head and neck in this patient population.

Methods: Retrospective cohort study performed at two tertiary referral centers between August 2016 and May 2020.

Results: Nine hundred and seventy-nine patients underwent MVFTT during the study period; of these 47 (5%) patients were taking chronic immunosuppressive medications. The most common indications for immunosuppression were solid organ transplant and autoimmune disease. Fourteen (30%) patients had surgical complications within 30 days of surgery: 8 (17%) wound dehiscences, 6 (12%) hematomas, and 2 (4%) surgical site infections. There was one total and one partial flap failure with a 30-day reoperation rate of 4%.

Conclusions: MVFTT of the head and neck appears to be safe in patients on chronic pharmacologic immunosuppression.

Keywords: free flap; head and neck cancer; immunosuppression; microvascular surgery; organ transplant.

MeSH terms

  • Free Tissue Flaps* / blood supply
  • Head and Neck Neoplasms* / complications
  • Head and Neck Neoplasms* / drug therapy
  • Head and Neck Neoplasms* / surgery
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Neck / surgery
  • Plastic Surgery Procedures* / adverse effects
  • Postoperative Complications / epidemiology
  • Retrospective Studies