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Risk Factors Associated with Adverse Functional Outcomes in Free Flap Reconstructions of the Lower Extremity.

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Free flap reconstruction for lower limbs aims for ambulation, not just survival. Flap failure, infection, and obesity are key risks for poor outcomes, impacting patient mobility and function.

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Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Lower limb reconstruction using free flaps presents significant challenges.
  • Beyond flap survival, restoring independent ambulation is the ultimate goal.

Purpose of the Study:

  • Identify risk factors for adverse functional outcomes in lower extremity reconstruction.
  • Analyze factors affecting ambulation and limb function post-microsurgery.

Main Methods:

  • Retrospective review of 516 free flap procedures (2006-2022).
  • Data collected on demographics, weight-bearing, ambulatory status, secondary amputation, and Lower Extremity Functional Scale (LEFS) scores.
  • Multivariate regression analysis identified risk factors for poor functional outcomes.

Main Results:

  • 86.4% achieved unassisted ambulation post-reconstruction.
  • Lower LEFS scores correlated with secondary amputation and obesity.
  • Flap failure and infections were significant risk factors for secondary amputation.

Conclusions:

  • Flap survival is insufficient; functional restoration and independent ambulation are primary goals.
  • Patient-specific factors and an individualized approach are crucial for successful lower extremity reconstruction.
  • Obesity and complications like flap failure/infection negatively impact long-term functional outcomes.