A Single Center Experience with Head to Toe Microsurgical Reconstruction in Bloodless Medicine Patients

Abstract Patients who decline blood transfusions, including members of the Jehovah's Witness faith, often face challenges when they require or desire prolonged operations such as free tissue transfer (FTT). This study aims to outline our institution's experience with treating bloodless medicine patients and offers the first anatomically comprehensive evaluation of FTT in this population. All patients undergoing FTT from 2017 to 2020 at a single institution were retrospectively reviewed. Patients who declined blood products were selected. Outcomes of interest included flap success, operative complications, and changes to hemoglobin measurements. Ten patients undergoing eleven FTT procedures were identified. Average age was 62.4 years(SD 7.6). Most patients were female (n=9) and Black (n=8). Average BMI was 31.3(SD 5.6), American Society of Anesthesiologists Physical Status (ASA PS) was 2.9(SD 0.5), and Charlson Comorbidity Index was 3.8(SD 1.1). Sites of FTT reconstruction were: breast (6), lower extremity (3), and scalp (2). Average operative time was 390 minutes(SD 85.1) with EBL averaging 170 mL(SD 100.4). The difference between preoperative hemoglobin to first postoperative hemoglobin measurement averaged 2.2 g/dL(SD 1.4). Average patient follow-up was 12 months(SD 7.8). Flap success occurred in ten cases. One patient with flap failure was successfully reconstructed with a second procedure. Despite a small, heterogeneous cohort, our success rate in this highly comorbid population indicates that FTT can be performed effectively for patients who cannot use blood products. Bloodless medicine protocols are beneficial to providers serving patients with transfusion restrictions and systems that strive to limit transfusion volume and risk.