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Elevating Lower Extremity Reconstruction: An Algorithmic Approach to Free Flap Re-elevation.

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Summary
This summary is machine-generated.

Re-elevating free flaps (FF) in lower extremity trauma can restore function. However, multiple re-elevations and infections negatively impact limb salvage and return to ambulation.

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Area of Science:

  • Orthopaedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Free flap (FF) reconstruction is crucial for soft-tissue coverage in severe lower extremity (LE) orthopaedic trauma.
  • Re-elevation of inset FFs may be necessary for limb salvage and functional restoration.
  • An algorithm and experience with LE FF re-elevation are presented.

Purpose of the Study:

  • To present an algorithm for lower extremity free flap re-elevation.
  • To review institutional experience with LE FF re-elevation.
  • To identify factors influencing successful limb salvage and return to ambulation.

Main Methods:

  • Retrospective review of adult patients with LE wounds requiring FF reconstruction (2016-2021).
  • Identification of patients requiring FF re-elevation.
  • Definition of successful FF re-elevation as limb salvage and return to ambulation.

Main Results:

  • 39 patients (9.5%) required FF re-elevation from 412 flap reconstructions.
  • 34 patients achieved successful FF re-elevation.
  • Increased number of re-elevations, need for orthopaedic access, and infections were negatively associated with limb salvage.

Conclusions:

  • Preoperative planning and flap preservation are key for successful FF re-elevation.
  • LE FFs can be safely re-elevated for hardware access or flap revision.
  • Multidisciplinary team management is essential for complex LE trauma cases.