Variables associated with 30‐day postoperative complications in lower extremity free flap reconstruction identified in the ACS‐NSQIP database

Summary Background Despite continuous surgical advances, reconstruction of complex lower extremity wounds remains challenging. The indication of local flaps or microsurgical free tissue transfer depends on the anatomical location and size of the defect, as well as the comorbidities and general condition of the patient. In this study, local and free flap reconstruction of distal lower extremity defects was assessed, and postoperative complications and limb salvage were analyzed. Methods A total of 34 patients were included in this retrospective study. Distal lower extremity defects were of traumatic (29%) and non-traumatic (71%) etiologies. Patient characteristics, flap selection, postoperative complications, and limb preservation within the first 12 months were assessed and compared by reconstructive treatment concept. Statistical analysis included parametric and non-parametric tests. The two-sided alpha was set at 5% for all statistical tests. Results While 21 patients were treated with local flaps, 13 patients underwent microsurgical free flap reconstruction. The most common comorbidities were peripheral vascular disease and diabetes. Local flaps included the gastrocnemius muscle flap, soleus flap, sural flap, and plantaris medialis flap. The most commonly used free flaps for soft tissue reconstruction were latissimus dorsi and gracilis muscle flaps. The overall lower extremity preservation rate was 94.1%. There was one case of below-knee amputation 1 month after free flap reconstruction, and one case of first-ray amputation of the foot after local flap coverage. Conclusion Reconstruction of lower extremity defects can be achieved by local or free flap reconstruction. Flap selection is influenced by anatomical location, defect size, and patient factors.

Download Full-text

Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0036-1593815 ◽

2016 ◽

Vol 02 (01) ◽

pp. e7-e14

Author(s):

Sören Könneker ◽

G.F. Broelsch ◽

J.W. Kuhbier ◽

T. Framke ◽

N. Neubert ◽

...

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Statistical Significance ◽

Group Versus ◽

Outcome Analysis ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Flap Survival ◽

Anastomotic Technique ◽

End To End

Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.

Download Full-text

Postoperative care in microvascular free flap reconstruction of the lower extremity: A systematic review

Orthoplastic Surgery ◽

10.1016/j.orthop.2020.10.003 ◽

2020 ◽

Vol 1-2 ◽

pp. 21-26

Author(s):

David D. Krijgh ◽

Milou M.E. van Straeten ◽

Marc A.M. Mureau ◽

Antonius J.M. Luijsterburg ◽

Pascal P.A. Schellekens ◽

...

Keyword(s):

Systematic Review ◽

Lower Extremity ◽

Free Flap ◽

Postoperative Care ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Microvascular Free Flap

Download Full-text

Microvascular Free Flap Reconstruction in Pediatric Lower Extremity Trauma: A 10-Year Review

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000160698.68234.6c ◽

2005 ◽

Vol 115 (6) ◽

pp. 1618-1624 ◽

Cited By ~ 45

Author(s):

Brian Rinker ◽

Ian L. Valerio ◽

Daniel H. Stewart ◽

Lee L. Q. Pu ◽

Henry C. Vasconez

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Lower Extremity Trauma ◽

Extremity Trauma ◽

Microvascular Free Flap

Download Full-text

Impact of Body Mass Index on Operative Outcomes in Head and Neck Free Flap Surgery

Otolaryngology ◽

10.1177/0194599818777240 ◽

2018 ◽

Vol 159 (5) ◽

pp. 817-823 ◽

Cited By ~ 7

Author(s):

Meghan M. Crippen ◽

Jacob S. Brady ◽

Alexander M. Mozeika ◽

Jean Anderson Eloy ◽

Soly Baredes ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Postoperative Complications ◽

Head And Neck ◽

Free Flap ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Flap Surgery ◽

Free Flap Surgery ◽

Increased Risk

Objective Analyze the risk for perioperative complications associated with body mass index (BMI) class in patients undergoing head and neck free flap reconstruction. Study Design and Setting Retrospective cohort study. Subjects and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of head and neck free flaps between 2005 and 2014 (N = 2187). This population was stratified into underweight, normal-weight, overweight, and obese BMI cohorts. Groups were compared for demographics, comorbidities, and procedure-related variables. Rates of postoperative complications were compared between groups using χ2 and binary logistic regression analyses. Results Underweight patients (n = 160) had significantly higher rates of numerous comorbidities, including disseminated cancer, preoperative chemotherapy, and anemia, while obese patients (n = 447) had higher rates of diabetes and hypertension. Rates of overall surgical complications, medical complications, and flap loss were insignificantly different between BMI groups. Following regression, obese BMI was protective for perioperative transfusion requirement (odds ratio [OR] = 0.63, P = .001), while underweight status conferred increased risk (OR = 2.43, P < .001). Recent weight loss was found to be an independent predictor of perioperative cardiac arrest (OR = 3.16, P = .006) while underweight BMI was not (OR = 1.21, P = .763). However, both weight loss and underweight status were associated with significantly increased risk for 30-day mortality (OR = 4.48, P = .032; OR = 4.02, P = .010, respectively). Conclusion Obesity does not increase the risk for postoperative complications in head and neck free flap surgery and may be protective in some cases. When assessing a patient’s fitness for surgery, underweight status or recent weight loss may suggest a reduced ability to tolerate extensive free flap reconstruction.

Download Full-text