Elmer Nicholas A, Laikhter Elizabeth, Hassell Natalie, Veeramani Anamika, Bustos Valeria P, Manstein Samuel M, Comer Carly D, Kinney Jacquelyn, Dowlatshahi Arriyan Samandar, Lin Samuel J
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Plast Surg (Oakv). 2024 Nov;32(4):711-719. doi: 10.1177/22925503231157093. Epub 2023 Feb 27.
Free tissue transfer is a valuable surgical option for the reconstruction of a myriad of complex lower extremity defects. Currently, there is a paucity of data that examines the risks of complications for each of these unique indications. Patients undergoing lower extremity free flap reconstruction from the ACS-NSQIP 2011-2019 database were stratified into groups based on the etiology and indication for reconstruction. Rates of major, surgical wound, and medical complications were compared over the first post-operative month. Multivariable logistic regression was used to identify complication predictors. 425 lower extremity free flaps were analyzed. The most common indications for lower extremity free flap reconstruction were wound-related (29%), malignancy (21%), and trauma (17%). Seventeen percent of free flaps had a major post-operative complication, 9% had a surgical wound complication, and 16% had a medical complication. There were no significant differences in major complications between the indications. However, the independent risk factors for major complications varied widely. Those with an indication of malignancy and those who received a musculocutaneous free flap were significantly more likely to have a surgical wound complication compared to the remaining cohort ( < 0.05). Those requiring free flap reconstruction for orthopedic hardware related concerns as well as those with wound related indications were significantly more likely to have a post-operative medical complication ( < 0.05). Understanding the unique risk profiles between the various indications and populations of patients undergoing lower extremity free flap reconstruction is critical for providing accurate risk estimations and optimizing post-operative outcomes and monitoring. microsurgery, lower extremity free flap, free flap reconstruction.
游离组织移植是修复多种复杂下肢缺损的一种重要手术方式。目前，针对这些独特适应症的并发症风险的研究数据匮乏。从2011 - 2019年美国外科医师协会国家外科质量改进计划（ACS - NSQIP）数据库中选取接受下肢游离皮瓣重建的患者，根据重建的病因和适应症进行分组。比较术后第一个月内的主要并发症、手术伤口并发症和医疗并发症发生率。采用多变量逻辑回归分析确定并发症的预测因素。分析了425例下肢游离皮瓣。下肢游离皮瓣重建最常见的适应症是伤口相关（29%）、恶性肿瘤（21%）和创伤（17%）。17%的游离皮瓣出现术后主要并发症，9%出现手术伤口并发症，16%出现医疗并发症。不同适应症之间的主要并发症无显著差异。然而，主要并发症的独立危险因素差异很大。与其他患者相比，适应症为恶性肿瘤的患者以及接受肌皮游离皮瓣的患者发生手术伤口并发症的可能性显著更高（<0.05）。因骨科内固定相关问题需要游离皮瓣重建的患者以及有伤口相关适应症的患者发生术后医疗并发症的可能性显著更高（<0.05）。了解下肢游离皮瓣重建不同适应症和患者群体之间独特的风险特征，对于提供准确的风险评估以及优化术后结果和监测至关重要。显微外科、下肢游离皮瓣、游离皮瓣重建
