203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions

The AAPS 102nd Annual Meeting

May 18-21, 2024 | The Westin Copley Place, Boston, MA

D34

Refining And Expanding Free Tissue Transfer For The Comorbid, Chronic Wound Population: Analyzing Multiplex Surgical Care In 300 Lower Extremity Free Flaps

Preview of Refining And Expanding Free Tissue Transfer For The Comorbid, Chronic Wound Population: Analyzing Multiplex Surgical Care In 300 Lower Extremity Free Flaps

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Poster Presenter

Karen Li

Authors

Karen Li, Samuel Huffman, Nisha Gupta, Brian Truong, Christian Lava, Jayson Atves, DPM, John Steinberg, DPM, Cameron Akbari, MD, Richard Youn, MD, Christopher Attinger, MD, Karen Evans, MD

Affiliations

Georgetown School of Medicine, Department of Plastic Surgery, Medstar Georgetown University Hospital, Department of Vascular Surgery, Medstar Georgetown University Hospital, Department of Podiatric Surgery, Medstar Georgetown University Hospital, Department of Podiatry, Medstar Georgetown University Hospital

Part of Topic

Hand/Extremity

Refining a Multidisciplinary “Vasculo-plastic” Approach to Limb Salvage: An Institutional Review Examining 300 Lower Extremity Free Flaps

Introduction

The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The comorbidity burden of these patients often include diabetes mellitus, peripheral vascular disease, and end stage renal disease, which increases their risk of undergoing this procedure. Improvements in preoperative management, intraoperative surgical technique, and postoperative follow-up have allowed LE FTT to remain a viable reconstructive operative option despite higher risk profiles for patients. The authors present their 12-year institutional experience with 300 FTTs performed for LE limb salvage of chronic LE wounds.

Methods

LE FTTs performed by a single surgeon from 2011 to 2023 were reviewed. Demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, and complications were compared between the first 200 (Group 1, July 2011 – February 2020) and last 100 flaps (Group 2, February 2020 – January 2023) performed.

Results

•Compared to Group 1, Group 2 had significantly higher rates of:

•Diabetes (67.0% vs. 48.5%, p=0.002)

•Peripheral vascular disease (56.0% vs. 24.5%, p<0.001)

•History of venous thromboembolisms (13.0% vs. 6.0%, p=0.039)

•Venous reflux (81.9% vs. 67.8%; p=0.028), and preoperative venous thromboses on venous testing (25.5% vs. 10.5%; p=0.003)

•Pre-FTT endovascular interventions (23.0% vs. 16.5%, p=0.039) and vascular bypasses (4.0% vs. 0.0%, p =0.012).

•Group 2 had significantly higher rates of partial flap necrosis (7% vs. 3%; p=0.012)

Discussion

•Our study demonstrates that the post-operative success rates remained comparable between the two groups, despite a greater comorbidity profile in Group 2 patients

•Perioperative interventions to build on our vasculoplastic approach is important to follow through in the preoperative, intraoperative, and postoperative periods

•Intensive clinic follow-up, management of comorbidities, adherence to postoperative protocols, and diabetic foot care guidelines are integral to our multidisciplinary approach to complex limb salvage

•The wound center at our institution integrates several major subspecialties into a single clinic

Limitations: single-institution retrospective study design, cohorts were divided by time periods and COVID-19 impacted several years, possible bias in more recent FTT procedures compared to earlier retrospective review

Conclusion

FTT remains efficacious for treatment of chronic LE wounds among patients affected by greater comorbidity and worse peripheral vasculature. Utility of a highly integrated, multidisciplinary vasculopathic approach to complex salvage can help achieve successful short and long-term outcomes