Introduction: Free microvascular tissue transfers have revolutionized the reconstruction of composite and large tissue defects that cannot be effectively addressed with skin grafting or local flaps. A healthy recipient artery and vein are essential for successful flap transfers. However, in solid organ transplant candidates and recipients, challenges such as recipient artery and pedicle arteriosclerosis, prolonged operation/anesthesia time, and impaired wound healing may arise. This study aims to share our experience with free flap transfers for lower extremity wounds in this specific patient population.
Material and Methods: Seventeen free microvascular flap transfers were performed between 2017 and 2024 to reconstruct lower extremity ulcers. Patient demographics, etiology of the defect, reason for transplant/organ failure, hemodialysis status, flap type, recipient vessels, and early and late complications were documented.
Results: Eight patients were on the waiting list for kidney transplantation and underwent thrice-weekly hemodialysis. Five of them were kidney transplant recipients, while two patients had hepatic cirrhosis and were awaiting liver transplantation, and one patient had already undergone liver transplantation. Nine flaps utilized muscle flaps (latissimus dorsi, gracilis), while eight flaps were fasciocutaneous flaps. Two instances of flap failure were encountered in a patient with liver and kidney failure but without transplantation. Additionally, donor site healing problems were observed in four kidney transplant candidates and one liver transplant candidate.
Conclusion: Solid organ dysfunction and insufficiency significantly affect wound healing, and the timing of transplantation impacts the outcome of free microvascular tissue transfers. Our study demonstrates that with meticulous preoperative systemic assessments, free flap transfers can be successfully performed in solid organ transplant patients.