Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.
Microsurgery. 2024 Sep;44(6):e31231. doi: 10.1002/micr.31231.
Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction.
A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories.
A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10-15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years.
BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.
升高的体重指数（BMI）是术后并发症的已知围手术期危险因素，例如伤口愈合延迟和感染。然而，对于升高的 BMI 如何影响创伤后下肢（LE）微血管重建后的结果，人们的理解存在差距。
在一家一级创伤中心，对 2007 年至 2022 年期间接受创伤后下肢微血管重建的患者进行了回顾性研究。记录了患者的人口统计学、皮瓣/伤口详细信息、并发症和结局。将患者分为疾病控制中心的 BMI 类别。
共纳入 398 例患者，平均 BMI 为 28.2±5.8。LE 缺损的近一半（45%）位于小腿的远端三分之一，27.5%位于中间三分之一，34.4%位于近端三分之一。与筋膜皮瓣（16.8%）相比，大多数重建采用包含肌肉的皮瓣（74.4%）。手术入路包括游离皮瓣（47.6%）和局部皮瓣（52.5%）。III 类肥胖患者明显比非肥胖患者更不能活动（OR：4.10，95%CI 1.10-15.2，p=0.035）。在最终随访时，30.1%的 III 类肥胖患者能够活动，需要轮椅（42.3%）或辅助设备（26.9%）。根据肥胖状况，并发症发生率没有显著差异（0.704）。整个队列的平均随访时间为 5.8 年。
BMI 对于下肢重建中的患者护理和手术决策至关重要。需要进一步研究，以优化更高 BMI 患者的结局，从而有可能降低术后并发症的负担并增强整体患者恢复。
