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Mark K. Wax, MD; Eben L. Rosenthal, MD; Rodd Takaguchi, BS; James I. Cohen, MD, PhD; Peter E. Andersen, MD; Neal Futran, MD

Arch Otolaryngol Head Neck Surg. 2002;128:249-252.

Background  Atelectasis is one of the most common postoperative complications encountered in head and neck surgery. Risk factors include preexisting pulmonary disease, the procedure performed, and the length of anesthetic. Regional flaps used to reconstruct defects in the head and neck predispose to radiographic atelectasis. The rectus abdominis myocutaneous flap is usually transferred as a free tissue transfer. Harvesting the flap results in abdominal wall pain and postoperative splinting that may contribute to an increased development of atelectasis. To our knowledge, this issue has not been previously examined.

Design  Retrospective review.

Results  Fifty-three patients underwent rectus abdominis myocutaneous free flap reconstruction following major ablative procedures for head and neck cancer. The flap size ranged from 5 x 7 to 25 x 27 cm. Most flaps were 8 x 15 cm. The cutaneous area transferred ranged from 35 to 600 cm² (mean, 120 cm²). These patients were compared with a group of 53 patients who were matched for age, sex, length of the procedure, and stage of disease. Postoperative atelectasis was radiographically detected in 37 (70%) of the patients who underwent rectus abdominis myocutaneous free flap reconstruction vs 41 (77%) of the controls. Major atelectasis was not encountered in any patient in either group. Patients with a larger cutaneous paddle (>120 cm²) had a higher atelectasis score than patients with smaller cutaneous paddles (120 cm²) (P = .02).

Conclusions  The incidence of radiographic postoperative atelectasis in patients undergoing rectus abdominis myocutaneous free tissue transfer is high. The degree of atelectasis is small, and the clinical correlation and relevance are minimal.

From the Departments of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland (Drs Wax, Rosenthal, Cohen, and Andersen and Mr Takaguchi), and the University of Washington, Seattle (Dr Futran).

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