Indications and Complications After Extremity Reconstruction: A NSQIP Database Study

Pedicled muscle or fasciocutaneous flaps play a critical role in lower extremity reconstruction, yet there is limited national-level data examining how surgical indication influences postoperative outcome. This study evaluates the association between surgical indication and 30-day wound complications and reoperation following lower extremity pedicled flap reconstruction.

The National Surgical Quality Improvement Program (NSQIP) database (2005-2022) was reviewed to identify patients who underwent lower extremity "pedicled axial" flap reconstruction for the following indications, as determined by ICD-9/10 codes: (1) cancer/neoplasm, (2) trauma/open wound, (3) illness (eg, infection, pressure ulcers), (4) postoperative complications (eg, hardware/surgical site infection), and (5) other indications. Outcomes of interest included postoperative complications, such as reoperation or wound complications (surgical site infections and dehiscence) within 30 days. Bivariate and multivariable analyses were performed to evaluate associations between predictors and outcomes.

Among 880 patients, the most common indication was neoplasm/cancer (n=442, 50.2%), followed by trauma/open wounds (n=223, 25.3%), infection/pressure ulcers (n=157, 17.2%) and postoperative complications (n=37, 4.2%). Eighteen percent (n=158) of patients experienced postoperative wound complications (n=123, 14.0%) and/or required reoperation (n=64, 7.3%). Binary logistic regression adjusted for age and diabetes demonstrated that increased operation time (aOR: 1.003, 1.001-1.004, P =0.001) and disseminated cancer (aOR: 5.1, 95% CI: 2.5-10.5, P <0.001) were significantly associated with complications including reoperation. Surgical indication predicted wound complications excluding reoperation ( P =0.016), with cancer/neoplasm associated with 2.5 higher odds of adverse outcome compared with illness-categorized indications (aOR: 2.5, 95% CI: 1.2-5.1, P =0.013).

Lower extremity flap reconstructions for neoplastic indications are associated with higher postoperative wound complication rates. Patients with disseminated cancer are particularly vulnerable adverse outcomes and reoperation.