Secondary Surgery after Lower Extremity Free Flap Reconstruction

Area of Science:

• Orthopedics
• Plastic Surgery
• Reconstructive Surgery

Background:

• Microsurgical free tissue transfer is a critical reconstructive option for lower extremity limb salvage.
• Functional and aesthetic outcomes may necessitate secondary operations for optimal results.

Purpose of the Study:

• To identify predictors of secondary surgery following lower extremity free tissue transfer.
• To categorize secondary procedures into those for wound closure and refinement.

Main Methods:

• A multi-institutional retrospective cohort study of 420 lower extremity free tissue transfers (2002-2020).
• Analysis of patient data including wound cause, flap type, comorbidities, and need for secondary surgery.
• Multivariable logistic regression to determine independent predictors of secondary procedures.

Main Results:

• 57% of patients underwent secondary surgery after free tissue transfer.
• Diabetes (OR 2.0) and latissimus dorsi flaps (OR 2.4) predicted wound closure procedures.
• Fasciocutaneous (OR 3.6) and myocutaneous (OR 3.0) flaps predicted refinement procedures compared to muscle-only flaps.

Conclusions:

• The majority of lower extremity free tissue reconstructions require secondary procedures.
• Predictors of secondary surgery have been identified, aiding in patient expectation management for limb salvage.
• Understanding these predictors can optimize reconstructive planning and patient counseling.