Nutritional markers for predicting lower extremity free tissue transfer outcomes in the chronic wound population

Abstract

Background Optimizing nutritional status is critical to maximize flap success and healing. Prealbumin and albumin have been utilized as easily obtained proxies for overall nutritional status. The aim of this study was to investigate whether these markers are correlated with healing time and overall flap healing after lower extremity (LE) free tissue transfer (FTT) in the chronic wound population. Methods A retrospective review of LE chronic wound FTT patients treated by a single surgeon at our institution from 2011 to 2020 was performed. Data collected included demographics, comorbidities, flap characteristics, and perioperative labs. The outcomes of interest were flap healing (FH) and time to flap healing (TFH). Results We identified 69 patients undergoing LE FTT for limb salvage meeting our inclusion criteria. When using a threshold of <3.5 g/dl for low albumin and < 20 mg/dl for low prealbumin, no significance was found between FH or TFH and preoperative albumin or preoperative prealbumin. With low albumin defined as <2.7 g/dl with the prealbumin threshold unchanged, TFH was significantly increased, and FH was significantly decreased compared with the defined normal preoperative albumin group. Conclusions Low preoperative albumin, when defined as <3.5 g/dl, and prealbumin did not correlate with TFH or FH. Contrarily, when defined as <2.7 g/dl, low preoperative albumin correlated significantly with increased TFH and decreased FH rates. Further investigation into validated biomarkers and their thresholds is needed to assess the effect of nutritional status on wound healing and guide perioperative optimization.

Positive Bacterial Cultures on Spinal Wound Closure Do Not Predict Postoperative Outcomes

“…Increased BMI, history of DM, and history of more than 2 spinal surgeries, which have been identified in other single-institution studies of a similar patient population, were not associated with an increased rate of infection or reoperation in our study 4,5 . Nutritional status is critical to proper wound healing; surgical trauma induces hypermetabolism, whereas wound healing requires significant protein synthesis for proper formation of granulation tissue and anabolic pathways 20–23 . Specific to surgical wounds of the spine, previous studies have identified low prealbumin levels (<20 mg/dL) as an independent risk factor for postoperative infection as well as reoperation and increased length of stay after reconstruction 4,24 .…”

“…4,5 Nutritional status is critical to proper wound healing; surgical trauma induces hypermetabolism, whereas wound healing requires significant protein synthesis for proper formation of granulation tissue and anabolic pathways. [20][21][22][23] Specific to surgical wounds of the spine, previous studies have identified low prealbumin levels (<20 mg/dL) as an independent risk factor for postoperative infection as well as reoperation and increased length of stay after reconstruction. 4,24 Our investigation identified an association between prealbumin and seroma but not between other postoperative complications including infection or dehiscence.…”