Pedicled Flaps For High-risk Open Vascular Procedures Of The Lower Extremity: An Analysis Of The National Surgical Quality Improvement Project (NSQIP) Database
Shannon R. Garvey, MS, Amy Chen, BS, Allan A. Weidman, BS, Lauren Valentine, BS, Samuel J. Lin, MD, MBA, Bernard T. Lee, MD, MBA, MPH, Patric Liang, MD, Ryan P. Cauley, MD, MPH.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: Use of pedicled flaps in vascular procedures is associated with decreased infection and wound breakdown. We evaluated the risks and postoperative complications associated with lower extremity open vascular procedures with and without pedicled flaps. METHODS: The ACS-NSQIP database (2010-2020) was queried for CPT codes representing lower extremity open vascular procedures, including trunk and lower extremity pedicled flaps. Flap patients were compared to a randomized control group without flaps (1:3 cases to controls). Univariate and multivariate analyses were performed. RESULTS: 132,934 adults underwent lower extremity vascular procedures. Pedicled flaps were rare (0.7%) and performed more commonly in bypass surgery compared to without flaps (69% vs 64%, p<0.0001). Flap patients had higher comorbidities (Table 1). On univariate analysis, flap patients were more likely to experience wound (p=0.0026), mild systemic (p<0.0001), severe systemic (p=0.0452), and all-cause complications (p<0.0001). After adjusting for factors suspected to be associated with increased risk (gender, BMI, procedure type, ASA classification, functional status, diabetes, smoking, and albumin<3.5mg/dL), wound (p=0.096) and severe systemic complications (p=0.0719) were no longer significantly associated with flap patients. CONCLUSION: Patients undergoing lower extremity vascular procedures are associated with high risk of complications. Use of pedicled flaps remains uncommon and often performed in patients with greater comorbid disease. Use of pedicled flaps in high-risk patients may be associated with lower than expected wound and severe systemic complications after risk adjustment. 
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