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Understanding Risk in Emergent Reconstructive Flap Surgery.

Aulon Jerliu1,2, Lauren Harrison1,2, Charles Castiglione1,3

  • 1From the Department of Plastic and Reconstructive Surgery, University of Connecticut School of Medicine, Farmington, CT.

Plastic and Reconstructive Surgery. Global Open
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Summary

Emergency flap reconstruction significantly increases risks of mortality and major complications compared to elective procedures. Careful perioperative planning is crucial for managing these urgent cases.

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Area of Science:

  • Plastic Surgery
  • Surgical Outcomes
  • Health Services Research

Background:

  • Flap-based reconstruction is vital for soft tissue defect coverage.
  • Risks associated with emergency flap reconstructions are not well-defined.
  • This study compares outcomes of emergency versus elective flap reconstructions.

Purpose of the Study:

  • To compare postoperative outcomes between emergency and elective myocutaneous and fasciocutaneous flap reconstructions.
  • To identify specific risks and complications associated with emergency flap surgery.
  • To inform perioperative strategies for urgent reconstructive cases.

Main Methods:

  • Retrospective cross-sectional study using the American College of Surgeons National Surgical Quality Improvement Program database (2012-2023).
  • Patients undergoing flap reconstruction were categorized as emergency or elective.
  • Outcomes analyzed included 30-day mortality, major complications, surgical site infections, and overall complications, with multivariable logistic regression adjusting for confounders.

Main Results:

  • Emergency reconstructions (12.8% of 12,263 patients) were associated with higher unadjusted mortality (OR 4.77) and major complications (OR 2.44).
  • After risk adjustment, emergency status remained independently linked to increased mortality (aOR 14.78) and major complications (aOR 3.21).
  • Surgical site infection and overall complication rates did not remain significant after adjustment.

Conclusions:

  • Emergency flap reconstruction carries an independent risk of higher short-term mortality and major complications.
  • Findings highlight the need for enhanced perioperative planning, triage, and risk mitigation in urgent reconstructive surgery.
  • These results emphasize the importance of careful patient selection and management in emergency settings.