Bony Defects of the Foot Lead to High Rates of Transfer Lesion Development: Soft Tissue Reconstruction Is Not Enough in the Chronic Wound Population

Bhardwaj, Priya; Zolper, Elizabeth G.; Bekeny, Jenna C.; Abadeer, Andrew I.; Fan, Kenneth L.; Evans, Karen K.

doi:10.1097/01.gox.0000720676.10211.f7

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“…10 Consistent with these studies, we report an overall NL rate of 40.6% and found resection of the first metatarsal confers the highest risk of NL development (60.0%). 20 However, our study is unique in that it is exclusive to patients with large soft-tissue defects requiring FTT and it considers the competing influences of all three components of the bony tripod.…”

Section: Discussionmentioning

confidence: 99%

New and Recurrent Ulcerations After Free Tissue Transfer with Partial Bony Resection in Chronic Foot Wounds within a Comorbid Population: A Retrospective Cohort

Bhardwaj

Zolper

Abadeer

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Chronic foot wounds often require bony resection; however, altering the tripod of the foot carries a risk of new ulcer development nearing 70%. Resulting defects often require free tissue transfer (FTT) reconstruction; outcomes data for various bony resection and FTT options may guide clinical decision-making regarding bone and soft-tissue management. The authors hypothesized that alteration of the bony tripod will increase risk of new lesion development after FTT reconstruction. Methods: A single-center retrospective cohort analysis of patients undergoing FTT from 2011 through 2019 with bony resection and soft-tissue defects of the foot was performed. Data collected included demographics, comorbidities, wound locations, and FTT characteristics. Primary outcomes were recurrent lesion (RL) and new lesion (NL) development. Multivariate logistic regression and Cox hazards regression were used to produce adjusted odds ratios and hazard ratios. Results: Sixty-four patients (mean age, 55.9 years) who underwent bony resection and FTT were included. Mean Charlson Comorbidity Index was 4.1 (SD 2.0), and median follow-up was 14.6 months (range, 7.5 to 34.6 months). Wounds developed after FTT in 42 (67.1%) (RL, 39.1%; NL, 40.6%). Median time to NL development was 3.7 months (range, 0.47 to 9.1 months). First-metatarsal defect (OR, 4.8; 95% CI, 1.5 to 15.7) and flap with cutaneous component (OR, 0.24; 95% CI, 0.07 to 0.8) increased and decreased odds of NL development, respectively. Conclusions: First-metatarsal defects significantly increase NL risk after FTT. The majority of ulcerations heal with minor procedures but require long-term follow-up. Soft-tissue reconstruction with FTT achieves success in the short term, but NL and RL occur at high rates in the months to years after initial healing. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

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Section: Discussionmentioning

confidence: 99%