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A 13-year Experience Of Microsurgical Free Tissue Transfer For Chronic Lower Extremity Wound Limb Salvage: Long-term Outcomes From 356 Flaps At A Tertiary Wound Care Center
Rachel N. Rohrich, BS, Ryan P. Lin, MD, Sami Ferdousian, MS, Meghan E. Currin, BA, Woori Lee, BS, Richard C. Youn, MD, Christopher E. Attinger, MD, Cameron M. Akbari, MD, Karen K. Evans, MD.
Medstar Georgetown University Hospital, Washington, DC, USA.
PURPOSE: : Free tissue transfer (FTT) is a reconstructive option for patients with chronic lower extremity (LE) wounds. This study presents long-term outcomes of a large series of LE FTT in a comorbid population.
METHODS: A retrospective review of LE FTT from July 2011 to October 2024 was conducted. Flap success was defined as viability for the first 7 days postoperatively, and takeback referred to any return to the OR for flap revision within this period.
RESULTS: A total of 356 LE FTT were performed in 346 patients. Median age and body mass index were 57.5 (IQR: 18) years and 28.9 (IQR: 8.1) kg/m2. Median Charlson Comorbidity Index was 4 (IQR: 3), reflecting prevalent rates of diabetes (n=192 patients, 55.5%), peripheral vascular disease (n=185, 53.5%), and chronic kidney disease (n=38, 11.0%). Before reconstruction, 67 cases (18.9%) required endovascular optimization. Median wound size was 80 (IQR: 72) cm2. Most flaps were fasciocutaneous (n=202 flaps, 56.9%) or muscle (n=116, 32.7%), and utilized end-to-side anastomosis (n=310, 87.1%) with two venous anastomoses (n=290, 81.5%). Flap success rate was 96.1%. Takeback occurred in 17 flaps (4.9%), with a salvage rate of 70.6% (n=12). Patients were followed for a median of 15.7 (IQR: 27.6) months. Limb salvage occurred in 302 patients (87.3%) and 285 (85.1%) were ambulatory at final follow-up. Mortality rate was 5.8% (n=20).
CONCLUSION: This study represents the largest review of LE FTT for the treatment of chronic wounds and demonstrates that it is an effective tool in a patient population with multiple comorbidities.
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