Transfusion Rates in Free Flap Breast Reconstruction Patients: A Single-Centre Experience

Background

Previous studies have demonstrated low transfusion rates in breast reconstruction with deep inferior epigastric perforator (DIEP) flaps. We often employ the transverse upper gracilis (TUG) flap; however, perioperative transfusion rates have not previously been studied in this group. Due to the different dissection and exposure required, transfusion rates may vary.

We aim to ensure that perioperative resource use is appropriate and efficient, particularly group and save (G&S) sampling preoperatively. The objective of this study is to quantify transfusion rates in all patients undergoing free flap-based breast reconstruction and to determine the necessity of preoperative G&S sampling.

Methods

We retrospectively reviewed the electronic patient records, the electronic transfusion system, operation notes, and prescription records of all patients undergoing breast reconstruction using free-flap tissue transfer over one year. We identified transfusion of red blood cells and the current practice of perioperative G&S sampling in this patient group. These data were analysed using descriptive statistics.

Results

Of the 124 patients undergoing breast reconstruction with a free flap, a DIEP-based flap was deployed in 105, and a TUG flap in 14; in the remaining five, a selection of other flaps were utilised.

Three patients required transfusion of blood products during their admission (2.4%), all after DIEP flap-based reconstructions. All received two units of packed red blood cells, with one transfusion on each of days one to three postoperatively. The indication for all three was slow but ongoing bleeding with low haemoglobin (less than 80 g/L) on routine full blood count. All recovered well following this.

We found a low rate of transfusion in patients undergoing free flap breast reconstruction, with only three of 124 requiring transfusion (2.4%), all DIEP flaps. In addition to the published literature regarding DIEP flaps, we also include several TUG flaps in this cohort and several other flap types. None of the three transfusions were emergent in nature; all were completed with fully cross-matched blood according to local protocols.

Conclusion

We recommend that preoperative G&S sampling is not routinely necessary for patients undergoing free flap breast reconstruction. Preoperative G&S should be considered for those with a risk of atypical anti-red cell antibodies (for example, if previously transfused or pregnant), as cross-matched blood may take several days to be made available.

We expect this judicious use of G&S sampling to significantly reduce costs and laboratory resource use without a significant effect on the use of emergency red cell units.