Comparison of Complication Risks Following Lower Extremity Free Flap Reconstruction Based on Seven Pre-Operative...

Area of Science:

• Plastic Surgery
• Orthopedic Surgery
• Microsurgery

Background:

• Free tissue transfer is crucial for complex lower extremity defects.
• Limited data exists on complication risks for specific free flap indications.
• This study analyzes complication rates across diverse lower extremity reconstruction etiologies.

Purpose of the Study:

• To examine and compare complication risks associated with different indications for lower extremity free flap reconstruction.
• To identify independent predictors of major, surgical wound, and medical complications.
• To inform risk stratification and optimize outcomes in reconstructive microsurgery.

Main Methods:

• Analysis of 425 lower extremity free flaps from the ACS-NSQIP database (2011-2019).
• Stratification of patients by reconstruction indication (wound, malignancy, trauma, etc.).
• Comparison of complication rates and multivariable logistic regression to identify risk factors.

Main Results:

• Wound-related (29%), malignancy (21%), and trauma (17%) were common indications.
• Overall complication rates: 17% major, 9% surgical wound, 16% medical.
• Malignancy and musculocutaneous flaps increased surgical wound complications; orthopedic hardware and wound indications increased medical complications.

Conclusions:

• Risk profiles for lower extremity free flap reconstruction vary significantly by indication.
• Accurate risk estimation requires understanding these specific patient and indication-based risks.
• Optimizing post-operative monitoring and outcomes necessitates tailored approaches based on the reason for reconstruction.