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

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.