A retrospective evaluation of 182 free flaps in extremity reconstruction and review of the literature

Arakelyan, Sergey; Aydogan, Emrah; Spindler, Nick; Langer, Stefan; Bota, Olimpiu

doi:10.3205/iprs000162

Cited by 10 publications

(10 citation statements)

References 46 publications

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“…For our H&N population consisting of 2,381 patient who underwent RFS, 4.2% of them (100 patients) developed SSI, which is in discordance with the range reported in existing literature (7,8,30,31). In a study by Lebo et (32). In our analysis, we have separated patients who performed RFS of either extremity due to the different etiologies of RFS and the different potential risk factors that might lead to SSI in each.…”

Section: Discussionmentioning

confidence: 44%

“…As for extremity reconstruction, the incidence of SSI following RFS in either extremity was lower than the one reported in the literature by Arakelyant et al (27.5%) who analyzed the extremities combined ( 32 ). In our analysis, we have separated patients who performed RFS of either extremity due to the different etiologies of RFS and the different potential risk factors that might lead to SSI in each.…”

Section: Discussionmentioning

confidence: 53%

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Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

et al. 2023

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PurposeRates of surgical site infection (SSI) following reconstructive flap surgeries (RFS) vary according to flap recipient site, potentially leading to flap failure. This is the largest study to determine predictors of SSI following RFS across recipient sites.MethodsThe National Surgical Quality Improvement Program database was queried for patients undergoing any flap procedure from years 2005 to 2020. RFS involving grafts, skin flaps, or flaps with unknown recipient site were excluded. Patients were stratified according to recipient site: breast, trunk, head and neck (H&N), upper and lower extremities (UE&LE). The primary outcome was the incidence of SSI within 30 days following surgery. Descriptive statistics were calculated. Bivariate analysis and multivariate logistic regression were performed to determine predictors of SSI following RFS.Results37,177 patients underwent RFS, of whom 7.5% (n = 2,776) developed SSI. A significantly greater proportion of patients who underwent LE (n = 318, 10.7%) and trunk (n = 1,091, 10.4%) reconstruction developed SSI compared to those who underwent breast (n = 1,201, 6.3%), UE (n = 32, 4.4%), and H&N (n = 100, 4.2%) reconstruction (p < .001). Longer operating times were significant predictors of SSI following RFS across all sites. The strongest predictors of SSI were presence of open wound following trunk and H&N reconstruction [adjusted odds ratio (aOR) 95% confidence interval (CI) 1.82 (1.57–2.11) and 1.75 (1.57–1.95)], disseminated cancer following LE reconstruction [aOR (CI) 3.58 (2.324–5.53)], and history of cardiovascular accident or stroke following breast reconstruction [aOR (CI) 16.97 (2.72–105.82)].ConclusionLonger operating time was a significant predictor of SSI regardless of reconstruction site. Reducing operating times through proper surgical planning might help mitigate the risk of SSI following RFS. Our findings should be used to guide patient selection, counseling, and surgical planning prior to RFS.

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Section: Discussionmentioning

confidence: 44%

Section: Discussionmentioning

confidence: 53%

Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

et al. 2023

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“…The free anterolateral thigh (ALT) flap has become over the years a workhorse flap in reconstructive surgery. With a reliable blood supply, it can be harvested as an extended flap to cover extremely large soft tissue defects [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap—a case report

et al. 2023

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Background Extensive loss of soft tissue and bone due to neoplasia, trauma, or infection in extremities often leads to amputation. Case presentation We present the case of a 72-year-old female patient presenting with an extended cutaneous squamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26 × 20-cm soft tissue and 15-cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successful reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap, and an internal fixation with plate and screws. Two years after the original surgery, the patient is relapse-free and mobile, with adequate function of the reconstructed foot. Conclusions Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.

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“…The free anterolateral thigh ( ALT) ap has become over the years a workhorse ap in the reconstructive surgery. With a reliable blood supply, it can be harvested as an extended ap in order to cover extremely large soft tissue defects [5].…”

Section: Introductionmentioning

confidence: 99%

Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap – A case report

Bota

Meier

Garzarolli

et al. 2022

Preprint

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Background: Extensive loss of soft tissue and bone due to neoplasia, trauma or infection in extremities often lead to amputation. Case presentation: We present the case of a 72 year old female patient presenting with an extended cutaneous scquamous cell carcinoma of the lower leg, developed on top of necrobiosis lipoidica. After achieving the R0 resection, a 26X20 cm soft tissue and 15 cm tibial bone defect resulted. The contralateral leg had been lost due to the same disease 18 years before. We achieved a successfull reconstruction of the leg using a pedicled fibula transplantation, an extended anterolateral thigh perforator flap and an internal fixation with plate and screws. Two years after the original surgery the patient is relaps-free and mobile, with adequate function of the reconstructed foot. Conclusions: Our case presented a unique combination of pedicled fibula transplantation and free extended ALT perforator flap to reconstruct an extensive defect after resection of a rare cSCC on top of NL. In selected cases, the boundaries of limb salvage can be pushed far beyond the current standards of treatment.

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A retrospective evaluation of 182 free flaps in extremity reconstruction and review of the literature

Cited by 10 publications

References 46 publications

Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

Predictors of surgical site infection following reconstructive flap surgery: A multi-institutional analysis of 37,177 patients

Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap—a case report

Lower leg reconstruction after resection of a squamous cell carcinoma on necrobiosis lipoidica with a pedicled fibula and an extended anterolateral thigh flap – A case report

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