Secondary Surgery following Lower Extremity Free Tissue Reconstruction
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Microsurgical free tissue transfer may be the only reconstructive option for lower extremity limb salvage. However, the functional and aesthetic results following free tissue reconstruction after initial salvage may be suboptimal requiring secondary procedures to facilitate wound healing and refinement.1,2 PURPOSE: The authors studied the rate of secondary surgery after lower extremity free tissue reconstruction and identified associated factors for secondary surgery METHODS: A multi-institutional retrospective cohort study was performed, including patients who underwent lower extremity free tissue transfer from January 2002 to December 2019. The median follow-up time was 17 months. Our primary outcome variable was the presence of secondary surgery after free tissue transfer for lower extremity reconstruction. Independent variables (wound etiology, flap, donor type, recipient, co-morbidities, etc.) were collected. Secondary surgery was categorized as (1) wound closure procedures and (2) refinement procedures. Multivariable logistic regression was performed to determine which variables were independently associated with the outcome. RESULTS: In total, 420 free tissue transfers for lower extremity reconstruction were identified. Secondary surgery was performed in 57% of the patients who underwent free tissue reconstruction to the lower extremity. Wound closure procedures comprised 43% of the cohort, and refinement procedures 14% of the cohort. Patients with a myocutaneous free flap were found to be more likely to undergo secondary surgery (OR: 2.2, P: 0.045, 95% CI: 1.02–4.9) and oncologic patients who underwent chemotherapy were more likely to undergo a secondary procedure when compared with oncologic patients who did not undergo chemotherapy (OR: 2.9, P: 0.048, 95%, CI: 1.01–8.1). Patients with the ankle as recipient site were less likely to undergo a secondary procedure compared with patients with a recipient site other than the ankle (OR: 0.60, P: 0.022, CI: 0.39–0.93). CONCLUSIONS: The majority of lower extremity free tissue reconstructions underwent secondary procedures to provide definitive wound closure and/or refinement. Overall, patients who underwent a myocutaneous lower extremity free flap were found to be more than twice as likely to undergo secondary procedures than patients with other flap types. REFERENCES: 1. Kotsougiani D, Platte J, Bigdeli AK, et al. Evaluation of 389 patients following free-flap lower extremity reconstruction with respect to secondary refinement procedures. Microsurgery. 2018;38(3):242–250. 2. Cho EH, Shammas RL, Carney MJ, et al. Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis. Plast Reconstr Surg. 2018 Jan;141(1):191–199.
Institution: Harvard University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4309238060