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Indications and Complications After Extremity Reconstruction: A NSQIP Database Study.

Clara E Tandar1, Margaret Wang1, Ali Mansour1

  • 1Warren Alpert Medical School, Brown University, Providence, RI.

Annals of Plastic Surgery
|March 24, 2026
PubMed
Summary
This summary is machine-generated.

Lower extremity flap reconstruction for cancer is linked to more wound complications and reoperations. Patients with advanced cancer face higher risks of adverse outcomes.

Keywords:
Lower extremity reconstructionPedicled flapWound complications

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Area of Science:

  • Orthopedic Surgery
  • Plastic Surgery
  • Oncology

Background:

  • Pedicled muscle or fasciocutaneous flaps are vital for lower extremity reconstruction.
  • Limited national data exists on how surgical indication impacts outcomes.
  • This study examines the link between surgical indication and 30-day wound complications/reoperation.

Purpose of the Study:

  • To evaluate the association between surgical indication and postoperative outcomes.
  • To identify risk factors for wound complications and reoperation after lower extremity flap reconstruction.
  • To compare complication rates across different indications for flap surgery.

Main Methods:

  • Utilized the National Surgical Quality Improvement Program (NSQIP) database (2005-2022).
  • Included patients undergoing lower extremity pedicled axial flap reconstruction.
  • Analyzed indications (cancer, trauma, illness, etc.) and 30-day outcomes (complications, reoperation) using bivariate and multivariable analyses.

Main Results:

  • Neoplasm/cancer was the most frequent indication (50.2%).
  • Overall, 18% of patients experienced wound complications and/or reoperation.
  • Disseminated cancer significantly increased odds of complications (aOR: 5.1) and reoperation. Cancer indications had 2.5x higher odds of complications than illness indications.

Conclusions:

  • Lower extremity flap reconstructions for neoplastic indications are associated with higher postoperative wound complication rates.
  • Patients with disseminated cancer are particularly vulnerable to adverse outcomes and reoperation.
  • Surgical indication is a significant predictor of wound complications following flap reconstruction.