Atelectasis after free rectus transfer and abdominal wall reconstruction

Background. Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis. Methods. In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath. Results. Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n = 29) of augmented patients versus 83% (n = 19) of primary closure patients. Major atelectasis in 41% (n = 13) of augmented patients versus 61% (n = 14) of primary closure patients p <.05. The incidence of atelectasis was independent of skin flap size and operative times. Conclusions. The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest.