Association of Preoperative Debridements With Outcomes of Lower Extremity Reconstruction

Lower extremity (LE) reconstruction is vital for restoring form and function after traumatic injuries, chronic wounds, or oncologic resections. Preoperative and intraoperative debridements are standard procedures that remove necrotic tissue, reduce bacterial load, and promote a healthy wound environment for soft tissue coverage. We aim to characterize how the extent and timing of preoperative debridement influences flap outcomes and postoperative complications.

A retrospective review was conducted at a level 1 trauma center from 2007 to 2022 for patients who underwent LE microsurgical flap-based reconstruction. Demographic information, injury details, flap details, number and dates of preoperative debridements, complications, and ambulatory outcomes were abstracted. The primary outcome measures were flap-related and postoperative infectious complications, modeled with multiple regression.

A total of 171 patients underwent preoperative debridement before microsurgical LE reconstruction. The mean preoperative debridement was 3.1 ± 1.9. More debridements were associated with an increased risk of postoperative infection (odds ratio 1.62; 95% confidence interval 1.06-2.49; P = 0.034) but a significantly reduced risk of flap necrosis (odds ratio 0.54; 95% confidence interval 0.33-0.88; P = 0.014). There was no significant association between the time interval from injury to first debridement and complication risk.

While debridement timing was not significantly associated with infection rates or flap outcomes, the number of debridements correlated with increased infectious complications but reduced flap necrosis. A balanced debridement approach is essential to optimize wound bed preparation while minimizing infection risks. Future prospective, multicenter studies are needed to validate these findings and refine debridement protocols, enhancing LE reconstruction outcomes.