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A Thirty-Eight Year Evolution of Post-Traumatic Lower Extremity Reconstruction with Free Flaps at NYU Medical Center
Tomer Avraham, MD, Rohini L. Kadle, BS, Joshua Cohen, BS, William Hambley, BS, Alejandro Gomez-Viso, BS, William Rifkin, BS, Daniel Ceradini, MD, Pierre B. Saadeh, MD, Vishal Thanik, MD, Jamie P. Levine, MD.
NYU Langone Medical Center, New York, NY, USA.

PURPOSE:
Review trends in post-traumatic microvascular lower extremity reconstructions at a single academic center.
METHODS:
A prospectively maintained microvascular registry was queried for patient and operative variables.
RESULTS:
Between 1976 and 2014 651 free flaps were performed for lower extremity trauma reconstruction. 75% of patients were male with a mean age of 37. Case volume peaked by the 1980’s and then significantly declined in the mid 1990’s (fig1). The frequency of muscle flaps and fasciocutaneous flaps has been divergent, with muscle flaps the predominant choice into the 2000’s, following an initial period of exclusive groin flap usage. Over the past five years this trend has reversed, with 80% of reconstructions now utilizing fasciocutaneous flaps (fig1). Subset analysis demonstrates that the popularity fasciocutaneous flaps correlates to distinct “flap eras”, starting with the groin flap, followed by the parascapular flap, and most recently the ALT (fig2).
CONCLUSION:
The significant decrease in post-traumatic lower extremity free flaps at our institution over the past twenty years may represent changing injury or referral patterns, increased flap success, and use of non-free flap adjuncts such as wound vacs. Recognition of the advantages of the ALT for this indication correlates with an era of fasciocutaneous based reconstruction.


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