Li Karen R, Lava Christian X, Neughebauer Monique B, Rohrich Rachel N, Atves Jayson, Steinberg John, Akbari Cameron M, Youn Richard C, Attinger Christopher E, Evans Karen K
Georgetown University School of Medicine, Washington, DC 20007, USA.
George Washington University, Washington, DC 20052, USA.
J Clin Med. 2024 Apr 20;13(8):2406. doi: 10.3390/jcm13082406.
The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their multidisciplinary institutional experience with a review of 300 FTTs performed for the complex LE limb salvage of chronic LE wounds. A single-institution, retrospective review of atraumatic LE FTTs performed by a single surgeon from July 2011 to January 2023 was reviewed. Data on patient demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, postoperative complications, and long-term outcomes were collected. A total of 300 patients who underwent LE FTT were included in our retrospective review. Patients were on average 55.9 ± 13.6 years old with a median Charlson Comorbidity Index of 4 (IQR: 3). The majority of patients were male (70.7%). The overall hospital length of stay (LOS) was 27 days (IQR: 16), with a postoperative LOS of 14 days (IQR: 9.5). The most prevalent comorbidities were diabetes (54.7%), followed by peripheral vascular disease (PVD: 35%) and chronic kidney disease (CKD: 15.7%). The average operative LE FTT time was 416 ± 115 min. The majority of flaps were anterolateral thigh (ALT) flaps (52.7%), followed by vastus lateralis (VL) flaps (25.3%). The immediate flap success rate was 96.3%. The postoperative ipsilateral amputation rate was 12.7%. Successful limb salvage is possible in a highly comorbid patient population with a high prevalence of diabetes mellitus, peripheral vascular disease, and end-stage renal disease. In order to optimize patients prior to their LE FTT, extensive laboratory, arterial, and venous preoperative testing and diabetes management are needed preoperatively. Postoperative monitoring and long-term follow-up with a multidisciplinary team are also crucial for long-term limb salvage success.
游离组织移植（FTT）用于治疗慢性、不愈合的下肢（LE）伤口疗效显著。管理患者合并症、控制感染、评估血流状况和生物力学功能这四大支柱对于成功保肢至关重要。作者介绍了他们的多学科机构经验，并回顾了为复杂的慢性LE伤口保肢而进行的300例FTT。对一名外科医生在2011年7月至2023年1月期间进行的非创伤性LE FTT进行了单机构回顾性研究。收集了患者人口统计学、合并症、术前管理、术中细节、皮瓣结果、术后并发症和长期结果的数据。我们的回顾性研究共纳入了300例行LE FTT的患者。患者平均年龄为55.9±13.6岁，查尔森合并症指数中位数为4（四分位间距：3）。大多数患者为男性（70.7%）。总体住院时间（LOS）为27天（四分位间距：16），术后住院时间为14天（四分位间距：9.5）。最常见的合并症是糖尿病（54.7%），其次是外周血管疾病（PVD：35%）和慢性肾病（CKD：15.7%）。平均手术LE FTT时间为416±115分钟。大多数皮瓣为股前外侧（ALT）皮瓣（52.7%），其次是股外侧肌（VL）皮瓣（25.3%）。皮瓣即刻成功率为96.3%。术后同侧截肢率为12.7%。在患有糖尿病、外周血管疾病和终末期肾病的高合并症患者群体中实现成功保肢是可能的。为了在患者进行LE FTT之前优化其状况，术前需要进行广泛的实验室、动脉和静脉术前检查以及糖尿病管理。术后由多学科团队进行监测和长期随访对于长期保肢成功也至关重要。
