Comparative Analysis of Free Flap Outcomes in Solid Organ Transplant Recipients and Non-Transplant Controls

Sunday, October 12, 2025

8:30 AM - 8:36 AM EDT

Location: 127

Disclosure(s):

Hani Samarah, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Adam J. Luginbuhl, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Arielle G. Thal, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Solid organ transplant recipients undergoing reconstructive surgery face challenges from immunosuppression and comorbidities like diabetes and chronic kidney disease, impairing healing and raising thrombotic risks. This study evaluates outcomes after free flap surgery in organ transplant recipients, offering insights for optimizing care in this high-risk population.

Methods: A retrospective cohort analysis of free flap surgeries from 2018–2024 included 14 transplant recipients and 23 non-transplant patients. Demographics, comorbidities, flap types, and outcomes—including healing (complete wound closure within eight weeks) and 30-day post-operative adverse events—were compared. Kaplan-Meier survival analysis and Cox proportional hazards models evaluated survival, while t-tests, Mann-Whitney U tests, and chi-squared or Fisher’s exact tests were used for statistical comparisons, with significance at p < 0.05.

Results: Transplant recipients had significantly lower overall survival than controls (log-rank, p=0.005), independent of time since transplant (p=0.9). Three recipients experienced adverse events within 30 days: two died within 7- and 9-days post-surgery, and one faced multiple complications, including infection, necrosis, wound dehiscence, fistula, UTI, embolic RCA-MCA infarct, and DVT. Delayed healing, (incomplete wound closure within eight weeks) was more common in recipients (21.4% vs. 4.3%, p=0.083). No differences were observed in Wound dehiscence (7.1% vs. 30.4%, p=0.209), infections (14.3% vs. 21.7%, p=0.898), unplanned OR returns (28.6% vs. 26.1%, p=1.0), length of stay (7 vs. 6.5 days, p=0.922), readmissions (14.3% vs. 17.4%, p=0.425), or ED visits (7.1% vs. 8.7%, p=0.926). Recipients had higher rates of chronic kidney disease (19.7% vs. 3.8%) and diabetes (14.8% vs. 7.7%).

Conclusions: Free flap surgery in transplant recipients poses significant risks, including severe complications and reduced survival. Delayed healing and comorbidities remain key challenges. Multi-institutional pooled data analysis is ongoing to strengthen findings.

Presenting Author(s)

Hani Samarah, BS

Medical Student
Florida International University (Wertheim) - Medical College
Little Rock, AR, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Alana M. Platukus, BS

Medical Student
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.
AB

Andrew E. Briskin, BA

Medical Student
Sidney Kimmel Medical College at Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.
Harleen K. Sethi, DO

Fellow
Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure information not submitted.
Dev R. Amin, MD

Resident Physician
Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University
Philadelphia, PA, United States

Disclosure information not submitted.
KB

Kelly M. Bridgham, MD

Resident Physician
Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States

Disclosure information not submitted.
EM

Eric V. Mastrolonardo, MD

Resident
Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure information not submitted.
AL

Adam J. Luginbuhl, MD

Professor
Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Arielle G. Thal, MD

Assistant Professor
Jefferson University
Philadelphia, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
RG

Richard A. Goldman, MD

Associate Professor
Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University Hospital
Philadelphia, PA, United States

Disclosure information not submitted.

Senior Author(s)

Joseph M. Curry, MD

Professor
Thomas Jefferson University
Wynnewood, PA, United States

Disclosure information not submitted.