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Incidence and Risk Factors for Secondary Surgery and Amputation After Lower Extremity Limb Salvage
Ciara Brown1, Makenna Ash2, Ambika Menon1
1From the Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA.
Annals of Plastic Surgery
|October 30, 2024
Summary
Free tissue transfer (FTT) is crucial for lower extremity limb salvage, but most patients require further surgeries. Counseling patients on the high likelihood of secondary procedures and amputation risk factors is essential for managing expectations.
Area of Science:
- Orthopedic Surgery
- Reconstructive Surgery
- Trauma Surgery
Background:
- Lower extremity (LE) traumatic defects often necessitate free tissue transfer (FTT) for reconstruction.
- While FTT success is documented, data on secondary surgeries or amputation post-limb salvage is limited.
Purpose of the Study:
- To evaluate the incidence and indications for secondary surgeries after FTT in LE limb salvage.
- To identify risk factors associated with secondary surgeries and amputation.
Main Methods:
- Retrospective review of 92 LE free flaps for limb salvage from 2014-2022 at a level 1 trauma center.
- Primary outcome: incidence and indication of secondary surgeries post-FTT.
Main Results:
- 72% of patients required secondary surgeries, averaging 7 procedures per salvage.
- 10% of patients underwent amputation.
- Factors like BMI >30, frailty, flap type, and Masquelet technique correlated with amputation; older age and need for bone reconstruction correlated with secondary surgeries.
Conclusions:
- FTT is vital for limb salvage, but patients must be informed about the high probability of needing multiple surgeries.
- Identified risk factors can predict amputation likelihood, emphasizing the need for thorough preoperative counseling to align patient expectations with outcomes.
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