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Microsurgical Lower Extremity Reconstruction in the Subacute Period: A Safe Alternative.

Margaret J Starnes-Roubaud1, Mirna Peric1, Farshad Chowdry1

  • 1Division of Plastic Surgery, Department of Surgery, University of Southern California, Los Angeles, Claif.

Plastic and Reconstructive Surgery. Global Open
|August 25, 2015
PubMed
Summary

Delayed microsurgical reconstruction for lower extremity fractures (more than 15 days post-injury) showed similar outcomes to early reconstruction. This subacute approach is a safe alternative for limb salvage, achieving pain-free, functional extremities.

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Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Limb Salvage

Background:

  • Microsurgical reconstruction is key for limb salvage, aiming for a pain-free, functional extremity.
  • Early soft tissue coverage is ideal but often delayed (>15 days) due to various factors.
  • Half of patients at LAC+USC (2000-2010) had delayed reconstruction.

Purpose of the Study:

  • To evaluate outcomes of lower extremity microsurgical reconstruction based on timing.
  • To determine if delayed reconstruction impacts success rates.

Main Methods:

  • Retrospective chart review of patients needing lower extremity reconstruction.
  • Study period: January 2000 to December 2009 at LAC+USC.
  • Comparison of outcomes for reconstruction <15 days vs. >=15 days post-injury.

Main Results:

  • 51 patients identified with common injuries from motorcycle, MVA, and falls.
  • Most injuries were open (86%) and comminuted (74%), often in the distal tibia/pilon.
  • No significant difference in flap failure, osteomyelitis, bony union, or ambulation between early (<15 days) and delayed (>=15 days) reconstruction groups.

Conclusions:

  • Microsurgical reconstruction in the subacute period (>=15 days) is a safe and viable option.
  • Delayed reconstruction does not compromise key functional outcomes for lower extremity limb salvage.