Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps

Cho, Eugenia H.; Garcia, Ryan; Pien, Irene J.; Kuchibhatla, Maragatha; Levinson, Howard; Erdmann, Detlev; Levin, L. Scott; Hollenbeck, Scott T.

doi:10.1002/micr.22406

Cited by 28 publications

(16 citation statements)

References 37 publications

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“…Our study identified an association between diabetes and major complications in lower extremity free flap reconstruction. This is consistent with the findings from previous literature (Cho et al, ). Though complications may be more frequent in diabetic patients undergoing lower extremity free flaps, limb salvage can prolong survival and should be given full consideration prior to amputation (Ducic & Attinger, ; Oh, Lee, & Hong, ).…”

Section: Discussionsupporting

confidence: 94%

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

et al. 2019

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Background: Lower extremity free flaps are a common way to treat both traumatic and oncologic lower extremity wounds. These patients often suffer postoperative complications. We sought to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify variables associated with postoperative complications.Methods: Patients who had free flap procedure and a primary diagnosis code for lower extremity pathology were identified in the NSQIP database from 2006 to 2017. NSQIP includes data on preoperative, intraoperative, and postoperative variables, including information up to 30 postoperative days. Current procedural terminology (CPT) codes for free flaps and international classification of diseases (ICD) 9 and 10 codes for lower extremity pathology were used for our cohort. We examined overall and major complication rates. Major complications were defined as reoperation, readmission, organ space infection, or death. Univariate and multivariate analyses were used to identify associations with complications.Results: Four hundred and eighty-three patients underwent lower extremity free flaps. Overall complication rate was 31.6% and major complication rate was 14.9%.Prolonged operative time (OR = 2.81, CI:1.76-4.48, p < .001), preoperative steroid use (OR = 3.04, CI:1.12-8.29, p = .030), and preoperative anemia (OR = 4.10, CI:2.00-8.41, p < .001) were independently associated with any complication. Diabetes (OR = 2.56, CI:1.24-5.29, p = .011) and prolonged operative time (OR = 3.75, CI:2.17-6.47, p < .001) were independently associated with major complications. Conclusions: In lower extremity flap reconstruction, associations with overall complications include prolonged operative time, steroid use, and anemia. Associations with major complications included diabetes and prolonged operative time. These associations can be used to guide interventions on patients identified to have greater risk of complications.

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Section: Discussionsupporting

confidence: 94%

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

et al. 2019

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“…Managing lower extremity soft tissue defects from a vascular perspective is critical to successful free tissue transfer and the preservation of adequate blood supply to the foot. 4,15 The decision to perform an ETE or ETS arterial anastomosis is an important consideration in this reconstructive process, yet few large clinical outcomes studies have examined anastomotic technique as it applies to lower extremity free tissue transfer. Comparative outcomesbased evidence assessing the relative efficacy of ETE and ETS anastomoses will allow the surgeon to make more objective surgical decisions and optimize treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Microvascular Anastomoses Using End-to-End versus End-to-Side Technique in Lower Extremity Free Tissue Transfer

Cho

Garcia

Blau

et al. 2015

J reconstr Microsurg

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“…While LE salvage is oftentimes successful, reconstructive failure rates unfortunately remain higher than any other anatomic area. 8 Multiple scoring systems attempting to quantify the extent of soft tissue and neurovascular damage have been developed to help aid in whether to amputate or attempt limb salvage. While these scoring systems provide general insight, their clinical utility to predict subsequent amputation was largely disproven in the lower extremity injury severity scores (Lower Extremity Assessment Project) study.…”

mentioning

confidence: 99%

Risk Factors for Lower Extremity Amputation Following Attempted Free Flap Limb Salvage

Piwnica-Worms

Stranix

Othman

et al. 2020

J Reconstr Microsurg

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Background Traumatic limb salvage with free flap reconstruction versus primary amputation for lower extremity (LE) injuries remains an oft debated topic. Limb salvage has well-studied benefits and advances in microsurgery have helped reduce the complication rates. A subset of patients eventually requires secondary amputation after a failed attempt at limb salvage. A better understanding of risk factors that predict subsequent amputation after failed free flap reconstruction of LE injuries may improve operative management. Patients and Methods A retrospective study (2002–2019) was conducted on all patients who underwent free flap reconstruction of the LE within 120 days of the original inciting event at a single institution. Patient and operative factors were reviewed including comorbidities, severity of the injury, flap choice, outcomes, and complications. Predictors of subsequent amputation were analyzed. Results A total of 129 patients requiring free flap reconstructions for LE limb salvage met inclusion criteria. Anterolateral thigh flaps (70.5%) were performed most frequently. Secondary amputation occurred in 10 (7.8%) patients. Preoperative factors associated with eventual amputation include diabetes mellitus (p = 0.044), number of preoperative debridements (p = 0.013), evidence of any arterial injury/pathology (p = 0.008), specifically posterior tibial artery (p = < 0.0001), and degree of three-vessel runoff (p = 0.007). Operative factors associated with subsequent amputation include evidence of recipient artery injury/pathology (p = 0.008). Postoperative factors associated with secondary amputation include total flap failure (p = 0.001), partial flap failure (p = 0.002), minor complications (p = 0.037), and residual osteomyelitis (p = 0.028). Conclusion Many factors contribute to the reconstructive surgical team's decision to proceed with limb salvage or perform primary amputation. Several variables are associated with failed limb salvage resulting in secondary amputation. Further studies are required to better guide management during the limb salvage process.

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Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps

Abstract: Foot and ankle free tissue transfer may be performed with a low incidence of foot ischemia. Patients with diabetes, chronic ulceration, and an elevated preoperative platelet count are at higher risk for reconstructive failure. © 2015 Wiley Periodicals, Inc. Microsurgery 36:276-283, 2016.

Cited by 28 publications

References 37 publications

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

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

Microvascular Anastomoses Using End-to-End versus End-to-Side Technique in Lower Extremity Free Tissue Transfer

Risk Factors for Lower Extremity Amputation Following Attempted Free Flap Limb Salvage

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