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Complications Following Plastic Surgery in Solid Organ Transplant

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Complications Following Plastic Surgery in Solid Organ Transplant Research Article iMedPub Journals Journal of Aesthetic & Reconstructive Surgery 2016 http://www.imedpub.com ISSN 2472-1905 Vol. 2 No. 1: 10 DOI: 10.4172/2472-1905.100019 Complications Following Plastic Surgery Elizabeth Zellner1, in Solid Organ Transplant Recipients: A Rachel Lentz2, Descriptive Cohort Study Carolyn Chuang1 and Derek Steinbacher1 1 Department of Surgery, Yale University Abstract School of Medicine, New Haven, CT, USA 2 Department of Surgery, University of Background: In 2012, over 28,000 organ transplants were performed in the California San Francisco, San Francisco, United States. Long-term survival of solid organ transplant recipients (SOTRs) CA, USA has increased dramatically due to advancements in surgical technology and immunosuppressive therapies. As a result, the number of SOTRs seeking plastic and reconstructive surgery is increasing. However, the safety of plastic and reconstructive surgical procedures in SOTRs, a concerning clinical population for Corresponding author: Elizabeth Zellner postoperative complications due to immunosuppression, is not well characterized. Objective: Estimate prevalence of complications following plastic and reconstructive [email protected] surgery in SOTRs. MD, Chief Resident in Plastic Surgery, Design: Descriptive cohort study. Section of Plastic and Reconstructive Patients: All SOTRs who underwent surgical procedures performed by the Section Surgery, Department of Surgery, Yale of Plastic and Reconstructive Surgery faculty at Yale-New Haven Hospital between University School of Medicine, P.O. Box 2004 and 2011. 208041, New Haven, CT 06520, USA. Measurements: Transplant history (organ, reason for transplant, immunotherapy regimens) and plastic surgery history (procedure, results, and complications) Tel: 910 527 1871 were recorded. Results: 92 plastic surgical procedures were performed on 65 SOTRs in between Citation: Zellner E, Lentz R, Carolyn C, 2004-2011, including hand, reconstructive and cosmetic cases. 57 procedures et al. Complications Following Plastic were urgent or emergent, while 35 procedures were elective (of which 23 Surgery in Solid Organ Transplant Recipients: procedures (66%) were cosmetic). The overall complication prevalence was A Descriptive Cohort Study. J Aesthet 23.9%, most commonly related to wound healing complications (14.1%), bleeding Reconstr Surg. 2016, 2:1. (2.2%) and postoperative pain (2.2%). There was one death in the series (1.1%). Lower complication prevalence was observed in elective (6%) and cosmetic (4%) procedures. Conclusions: The overall complication prevalence for plastic surgery in SOTRs was 23.9%, with complication prevalence of 6% in elective cases. Given this prevalence, this report suggests that a history of transplantation is not an absolute contraindication to plastic and reconstructive surgery despite medical immunosuppression. In particular, elective procedures in suitable patients can have successful outcomes with minimal wound healing complications. Keywords: Solid organ transplantation; Safety; Plastic surgery Received: May 09, 2016; Accepted: May 23, 2016; Published: May 30, 2016 Introduction time, significant advances in transplant surgery and immunologic research led to longer lives for solid organ transplant recipients The first successful kidney transplant was performed by (SOTRs). Resultant improved quality of life led to increased Dr. Joseph Murray, a plastic surgeon, in 1952 [1, 2]. Since that demand for plastic and reconstructive surgery in SOTRs. One © Copyright iMedPub | This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php 1 Journal of Aesthetic & Reconstructive Surgery 2016 ISSN 2472-1905 Vol. 2 No. 1: 10 common indication for surgical management in SOTRs is plastic surgery procedure (Table 1). There were 45 kidney squamous cell carcinoma, which presents more frequently and recipients, 10 kidney and pancreas recipients, 6 liver recipients, at more advanced stage in SOTRs [3]. 3 heart recipients and 1 pancreas recipient. The 92 procedures represented both elective (35) and non-elective (57) operations Few studies investigate outcomes of surgeries performed on representing a wide range of plastic and reconstructive surgery SOTRs after transplantation. Case reports describe individual cases (Table 2). instances of surgery performed on SOTRs [4, 5]. Case series assessing safety of plastic surgery in SOTRs, including free During the acute perioperative period, patients continued their flap reconstruction [6], found no definitive contraindication existing immunosuppressive regimens without alterations. No to performing these procedures in carefully selected SOTRs stress dose steroids were given to any patients and no instances [6, 7]. In a 2009 nationwide survey, 25% of responding plastic of adrenocortical insufficiency occurred. surgeons reported they performed plastic surgery procedures During the 140 person-years of follow-up (mean 2 years, SD 2 in SOTRs with an extremely low complication prevalence based years), the overall observed complication prevalence was 23.9% on self-report [8]. Despite these previous reports, outcomes (n=22). The majority (n=15) were wound healing complications data on plastic surgery in SOTRs is still limited. The objective of in the setting of contaminated wounds that improved with this study was to examine complication prevalence in plastic further surgical debridement and meticulous wound care. Other surgery procedures by reviewing longitudinal data for all plastic complications observed included bleeding (n=2), pain requiring surgery cases in SOTRs performed at Yale-New Haven Hospital in hospital admission (n=2), respiratory difficulty prolonging hospital between 2004-2011. stay (n=2) and acute renal graft failure resulting in one patient’s Objectives death (n=1). Among elective procedures (n=35), the complication prevalence Our objective was to estimate the complication prevalence of was 6%. Among the cosmetic procedures (n=25), the complication plastic surgery procedures in SOTRs at Yale-New Haven Hospital. prevalence was 4%, representing one instance of postoperative Methods pain following a panniculectomy. We used a descriptive cohort design. We identified participants as There was no statistical difference between uncomplicated all adult SOTRs who underwent plastic and reconstructive surgery and complicated cases in terms of age (51 years vs. 53 years, at Yale-New Haven Hospital from 2004 to 2011. We longitudinally Table 1 65 adult SOTRs who underwent 92 distinct plastic and reconstructive followed their clinical course through 2014 to identify procedures. postoperative complications. Transplant, immunosuppression, and plastic surgery history were extracted and verified by authors Demographics Characteristic No. (%) RL and EZ via institutional review board-approved retrospective Total no. of patients 65 chart review. Follow-up data was available for all participants. Sex Complications were identified by examining provider notes in Male 36 (55.4) the electronic medical record and noting any problems reported Female 29 (44.6) on provider assessment and whether any interventions were Age, years - required. Expected complications included pain, bleeding, Mean 51 infection, and poor wound healing. Standard Deviation 11 Ethnicity Study bias was reduced by reporting all known cases at our White 39 (60) institution over eight years. Possible sources of bias include loss Black 16 (24.6) to follow up and surgeon-specific patient selection among SOTRs Hispanic 10 (15.4) desiring or requiring plastic and reconstructive surgery. Organ transplanted Kidney 45 (69.2) The number of cases performed at our institution during Kidney and Pancreas 10 (15.4) the study period determined the sample size. Complication Liver 6 (9.2) frequency was calculated using simple proportions. Association Heart 3 (4.6) analysis was performed using chi square tests, and surgery Pancreas 1 (1.5) history characteristics were compared using two-sided t-tests. Reason for transplantation Loss to follow up was not observed in this sample due to frequent Diabetes 20 (30.8) medical visits required of SOTRs. Polycystic Kidney Disease 8 (12.3) Glomerulonephritis 5 (7.7) Results Hypertension 4 (6.2) Hepatitis C Cirrhosis 3 (4.6) 65 adult SOTRs who underwent 92 distinct plastic and Other 25 (38.5) reconstructive procedures were identified. The sample was 55.4% Time from transplant to plastic surgery, years male, with an average age of 51 years (SD 11 years), and a mean Mean 8 of 8 years (SD 7 years) between transplantation and subsequent Standard Deviation 7 2 This article is available in: http://aesthetic-reconstructive-surgery.imedpub.com/archive.php Journal of Aesthetic & Reconstructive Surgery 2016 ISSN 2472-1905 Vol. 2 No. 1: 10 Table 2 92 procedures represented both elective (35) and non-elective cases. The complicated cases had an average duration of 168 (57) operations representing a wide range of plastic and reconstructive minutes while the uncomplicated cases had an average duration surgery cases. of 70 minutes (p=0.03) (Tables 1 and 2). Procedures Complications Performed Discussion Total No. of Procedures 92 22 Complication prevalence for plastic surgery procedures in SOTRs Hand Surgery 20 (22%) 4 (18%) was 23.9%, the majority being wound healing complications. Endoscopic carpal tunnel release 3 - As noted in previous papers, early, aggressive debridement Incision and drainage 3 - and broad spectrum antibiotics are advocated in these patients Arthroplasty/Arthrodesis
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