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Published on: April 26, 2019
Secondary amputation after lower extremity free-flap reconstruction.
F K Wong1, S Fruge1, M Z Meulendijks2
1Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
Infection is the primary reason for secondary lower extremity amputation after free-flap reconstruction. While many patients achieve prosthetic ambulation, chronic pain remains a significant concern post-amputation.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Microsurgical free-tissue transfer is a key reconstructive method for lower extremity limb salvage.
- Secondary amputation may be necessary despite successful initial free-flap reconstruction due to complications.
- Indications for secondary amputation include non-union, malunion, infection, hardware failure, or chronic pain.
Purpose of the Study:
- To determine the causes and outcomes of secondary amputation following lower extremity free-flap reconstruction.
- To analyze the etiology and patient-reported outcomes after secondary amputation in this patient cohort.
Main Methods:
- Retrospective cohort study of patients undergoing lower extremity free-flap reconstruction (2002-2020).
- Identification of patients who subsequently underwent amputation.
- Patient-reported outcomes assessed using the PROMIS® Pain Interference Scale and activities of daily living (ADLs) survey.
Main Results:
- 9.8% (40/410) of patients underwent secondary amputation.
- Infection was the most common cause (68%, 27/40) of secondary amputation.
- Of survey respondents, 80% (12/15) could ambulate with a prosthetic limb.
Conclusions:
- Infection is the leading etiology for secondary amputation after lower extremity free-flap reconstruction.
- While prosthetic ambulation is achievable for most, chronic pain is prevalent.
- Findings can inform patients about the risks and outcomes associated with lower extremity free-flap reconstruction.
