Analysis of frequency of pulmonary atelectasis in patients undergoing pectoralis major musculocutaneous flap reconstruction

Abstract

The incidence of pulmonary atelectasis following head and neck surgery is not well reported. This study retrospectively evaluated the incidence of pulmonary atelectasis in 161 head and neck cancer patients, with 152 being evaluable. There were 90 patients evaluated following pectoralis musculocutaneous flap reconstruction with their effective flap size and 71 nonflap patients as a control group. Clinical findings were correlated to radiographic scores. Of pectoralis musculocutaneous flap patients screened for preexisting pulmonary disease (PEPD), nine of 45 (20%) demonstrated pulmonary atelectasis in the first 24 hours compared with 10 of 39 or 25.6% nonflap controls. Major pulmonary atelectasis was not found in the pectoralis musculocutaneous flap patients by scoring criteria, and in only one of 39 (2.6%) nonflap patients. In flaps larger than 40 cm2, the incidence was eight of 37 (21.6%), with no major pulmonary atelectasis noted. Only one of nine (11.1%) patients with radiographic pulmonary atelectasis exhibited clinical symptoms (three of 10 or 30% control). In patients with PEPD and pectoralis musculocutaneous flaps, 22 of 45 (48.9%) had evidence of pulmonary atelectasis in contrast to 13 of 32 or 40.6% controls. There were two of 45 (4.4%) who had major pulmonary atelectasis with zero of 32 in the nonflap group. For flaps larger than 40 cm2, the incidence was 19 of 39 (48.7%) with two of 39 (5.1%) scored as major pulmonary atelectasis. The clinical correlation for this group and the major pulmonary atelectasis group was each approximately 50% compared to 15.4% for nonflap patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary Atelectasis After Reconstruction With a Rectus Abdominis Free Tissue Transfer

“…There was no difference in the atelectasis scores and categories between patients with rectus abdominis myocutaneous flaps and patients in the control group (Figure 2 and Figure 3, respectively). Arbitrarily, flaps with skin paddles greater than 120 cm 2 were considered large and were analyzed separately. Patients with large flaps demonstrated atelectasis 79% of the time compared with patients with smaller flaps, who demonstrated atelectasis 55% of the time.…”

“…Of these patients, 6.7% developed major atelectasis. Schuller et al 2 were unable to demonstrate an increased incidence of pulmonary atelectasis with pectoralis major myocutaneous flap reconstruction; however, they found that patients with PEPD exhibited a higher rate of pulmonary atelectasis. They also were unable to correlate between larger flaps and pulmonary atelectasis.…”

“…Fourteen patients had pedicled flaps, while 4 had free tissue transfer. The mean size of the flap was 128 cm 2 , with more than half of the flaps being 150 or 225 cm 2 . Eighty-three percent of the patients in their series showed some sign of atelectasis, whereas 17% developed major atelectasis.…”

“…Radiographic atelectasis has been demonstrated in 20% to 80% of patients, with major atelectasis being recorded in 1% to 10% of the patients. [1][2][3] Reconstruction of head and neck oncologic ablative defects often entails transfer of regional myocutaneous flaps. If these flaps are based on the chest wall, then splinting to diminish incisional pain may be a contributing factor for atelectasis.…”

“…The previously described studies [1][2][3] prompted us to look carefully at patients who underwent rectus abdominis myocutaneous free tissue transfer. The rectus abdominis myocutaneous flap provides substantial soft tissue bulk and cutaneous area.…”