Complications concerning free rectus abdominis muscle flaps in patients with portal hypertension.

A high level of suspicion is required when treating patients with a history of esophageal bleeding and portal hypertension. The preoperative workup must be extensive; if the reconstructive surgeon is considering the use of a rectus abdominis muscle transfer, noninvasive studies and an exhaustive physical examination are required. Factors affecting the microcirculation might also influence the patency rates of the venous anastomosis and require further study. When treating these patients, the surgeon must be aware that portal hypertension can exist without clinical evidence.