Effect of perioperative transfusion of old red blood cells on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous flap surgery for breast reconstruction

Lee, Hyekyoung; Kim, Dongho; Jin, Ung-Sik; Jeon, Young-Tae; Hwang, Jung‐Won; Park, Hee Pyoung

doi:10.1002/micr.22240

Cited by 21 publications

(20 citation statements)

References 34 publications

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“…Despite an adequate level of research comparing most complication rates there has been a relative paucity of attention given to comparing perioperative transfusion rates between these two reconstructions. Individually TRAM cases have been found to have transfusion rates ranging from 6% to 95% [10]. Similarly, DIEP cases have been reported to have transfusion rates ranging from 9.1% to as high as 80.3% [11] [12].…”

Section: Introductionmentioning

confidence: 98%

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

Amaratunga

Soliman

Lam

2017

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Objective: Abdominal based free flaps such as the Transverse Rectus Abdominis Myocutaneous (TRAM) flap and Deep Inferior Epigastric Perforator (DIEP) flap are essential tools in the reconstructive armamentarium post mastectomy. These reconstructions are often prolonged, complex and associated with complications. This study aims to compare the complication rate, particularly focusing on perioperative transfusions, between TRAM and DIEP flaps performed by the senior author in our tertiary referral centre. Methods: A retrospective review was conducted of one hundred and seven consecutive TRAM and DIEP flaps from 2000 to 2014. The two groups were analysed for demographics, preoperative risk factors and post-operative complications including blood transfusions, haematomas, flap losses, redo-anastomoses, flap infections, abdominal wound sequelae and non-surgical complications. Results: Sixty-three patients underwent 67 free/muscle sparing TRAM flaps and 35 patients underwent 40 DIEP flaps. There were no statistically significant differences in patient demographics or preoperative risk factors between the two groups. Five TRAM flap cases (7.9%) required transfusion whilst no DIEP flap cases required transfusion. This difference was not found to be statistically significant (p = 0.16). However, free/muscle-sparing TRAM flaps were found to have a significantly higher overall complication rate compared to DIEP flaps (23.8% vs. 5.7%, p = 0.02). Conclusion: The current study demonstrated no difference in perioperative transfusion requirement between TRAM and DIEP cases. There was however a significantly higher rate of overall complications associated with TRAM flaps warranting the authors to conclude that care be taken when opting for this reconstructive method.

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Section: Introductionmentioning

confidence: 98%

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

Amaratunga

Soliman

Lam

2017

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“…The resulting hematoma can compromise flap perfusion by an increased pressure on the microvascular pedicle or directly on the microvascular architecture of the flap. Also, such a bleeding often requires surgical re-exploration and the transfusion of blood products, which is associated with increased morbidity and cost and can further deteriorate the outcome of free tissue transfer [7], [8]. Therefore, the early identification of such patients as well as an early and targeted intervention seems desirable.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, postoperative bleeding can lead to hematoma formation, potentially compromising flap perfusion as well as necessitating the transfusion of blood products, which can further worsen outcomes [7], [8], [9]. Most of the available literature regarding the influence of coagulation on microvascular thrombosis and hematoma formation is based on the identification of preoperative markers [2], [10], [11], [12].…”

Section: Introductionmentioning

confidence: 99%

Insufficient fibrinogen response following free flap surgery is associated with bleeding complications

Kolbenschlag

Diehm²,

Daigeler

et al. 2016

GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW; 5:Doc22

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“…Evidence for detrimental outcomes with older blood include observational data in critical care [102], trauma [103], liver transplantation [104,105], breast reconstruction [106], cardiac surgery [107,108] and cardiology [102,109]. However, there is evidence challenging this association [110][111][112] and other data showing that fresh red cell-associated harm [113].…”

Section: Red Cell Storage Lesionmentioning

confidence: 99%

Red cell transfusion and the immune system

2014

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SummaryUnderstanding the complex immunological consequences of red cell transfusion is essential if we are to use this valuable resource wisely and safely. The decision to transfuse red cells should be made after serious considerations of the associated risks and benefits. Immunological risks of transfusion include major incompatibility reactions and transfusion-related acute lung injury, while other immunological insults such as transfusion-related immunomodulation are relatively underappreciated. Red cell transfusions should be acknowledged as immunological exposures, with consequences weighed against expected benefits. This article reviews immunological consequences and the emerging evidence that may inform risk-benefit considerations in clinical practice.

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Effect of perioperative transfusion of old red blood cells on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous flap surgery for breast reconstruction

Abstract: Perioperative transfusion of old RBCs can be associated with an increase in postoperative complications after free muscle sparing TRAM flap surgery.

Cited by 21 publications

References 34 publications

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

A Comparison of Perioperative Blood Transfusions and Other Complications Following Transverse Rectus Abdominis Myocutaneous Flaps versus Deep Inferior Epigastric Perforator Flaps

Insufficient fibrinogen response following free flap surgery is associated with bleeding complications

Red cell transfusion and the immune system

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