Improving Limb Salvage Outcomes in Racially and Ethnically Underserved Populations With a Highly Integrated...

In the setting of lower extremity (LE) limb salvage, studies have highlighted discrepancies in postoperative outcomes and amputation rates in racial and ethnic minority patients; however, this analysis has not been specifically evaluated in the setting of free tissue transfer (FTT) for chronic, nonhealing wounds. This study analyzes outcomes by race in our institution's 13-year experience with LE FTT.

All LE FTTs performed between 2011 and 2024 were retrospectively reviewed. Patient personal and socioeconomic demographics, operative details, and surgical outcomes were recorded.

A total of 335 FTTs were included for analysis: 49% White (n = 164), 45.4% Black (n = 152), and 5.7% Hispanic or Asian (n = 19). Significant differences were observed in age (P < 0.01), body mass index (P = 0.008), rates of diabetes (P = 0.004), end-stage renal disease (P = 0.023), and peripheral neuropathy (P = 0.028), with Black patients being the most comorbid. Income distribution, poverty rates (10.6% versus 6.7% versus 7.7%, P < 0.001), and percentage of individuals with a bachelor's degree or higher (27.2% versus 32.6% versus 30.1%, P = 0.001) were lowest among Black patients. There were no significant differences in any flap complications, postoperative below-knee amputations, ambulatory status at follow-up, or mortality rates.

With an integrated multidisciplinary approach to limb salvage, favorable outcomes and high success rates can be achieved in the setting of chronic, nonhealing wounds, regardless of race. By optimizing patients and ensuring long-term follow-up, the effects of socioeconomic characteristics can be mitigated.