Efficacy of Preoperative Autologous Blood Donation in Free TRAM Flap Breast Reconstruction

The objective of this study was to critically evaluate the use of autologous blood donation in patients who have surgical breast reconstruction using the fTRAM flap technique following mastectomy.

A retrospective chart review of 201 patients was performed. They were operated on at one community and one university hospital. For the analysis, cohorts of 101 blood donors and 100 control non-donors were established. Demographic and pre-morbid factors, as well as primary outcome variables, were evaluated.

The autologous donor and non-donor groups were not statistically different in any demographic categories, including age at operation, hospital in which surgery was completed, surgeon, timing of reconstruction (delayed vs. immediate), type of reconstruction (unilateral vs. bilateral), or site of flap harvest (ipsilateral or contralateral). Additionally, there were no significant differences in pre-morbid factors, including ASA status, hypertension, diabetes mellitus, obesity, respiratory disease, heart disease, or smoking history. The mean length of hospital stay was 6.65 days for the autologous donor group vs. 6.24 days for the control group, which was not statistically significant (p = 0.389). Total surgical complications, including total flap loss, partial flap loss, microvascular thrombosis, wound infection and dehiscence, fat necrosis, nerve pain, hernia, pneumonia, partial mastectomy flap loss, delayed healing, bulge, seroma, and UTI were more common in the autologous donor group (48% vs. 28%). This was statistically significant (p < 0.004). In addition, the autologous donor group was also more likely to receive a transfusion intraoperatively (13% vs. 0%, p < 0.001) or postoperatively (28% vs. 5%, p < 0.001), compared to the non-donor group. The authors' experience with autologous blood donation in preparation for free TRAM flap surgery led to the following conclusions: 1) autologous donation is associated with a significantly higher rate of transfusion intraoperatively and postoperatively; 2) there is a statistically significant higher rate of surgical complications associated with autologous blood donation and transfusion in fTRAM flap surgery. These findings lead the authors not to recommend autologous blood donation prior to fTRAM flap surgery.