Brown Ciara, Ash Makenna, Menon Ambika, Knaus William, Hernandez-Irizarry Roberto, Ghareeb Paul
From the Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, GA.
Emory University School of Medicine; Atlanta, GA.
Ann Plast Surg. 2025 Jan 1;94(1):75-78. doi: 10.1097/SAP.0000000000004125. Epub 2024 Oct 18.
Traumatic defects of the lower extremity (LE) require robust soft tissue to cover critical structures and facilitate healing. Free tissue transfer (FTT) is often necessary when local tissue is inadequate. While much of the literature emphasizes free flap viability in successful limb salvage, there is limited understanding regarding the need for additional surgeries or eventual amputation. We investigated a single institution's limb salvage efforts to better understand the need for additional procedures.
All patients who underwent LE limb salvage were retrospectively reviewed from 2014 to 2022 at a single level 1 trauma center. Our primary clinical outcome was the incidence and indication of secondary surgeries following FTT.
Ninety-two LE free flaps were performed during the study period. The mean age was 45 and majority were male. Seventy-two percent of flaps were fasciocutaneous while 28% were muscle flaps. Seventy-two percent of patients required a secondary surgery following FTT, with a mean of 7 total surgeries per salvage attempt. Ten percent of patients proceeded to amputation. Body mass index >30, higher frailty scores, flap type, and masquelet technique were significantly associated with subsequent amputation ( P = 0.017, P = 0.024, P = 0.005, P = 0.04, respectively). Older age, the need for bony reconstruction, and longer period from injury to flap coverage were significantly associated with the need for secondary surgeries ( P = 0.05, P < 0.001, and P = 0.22 respectively).
FTT is an important component of limb salvage. Patients undergoing limb salvage should be counseled on the need for secondary surgeries, as the process is often not complete following FTT. Furthermore, risk factors identified in this study may increase the likelihood of subsequent amputation. Thorough preoperative counseling is necessary to optimize the postoperative course and expectations in this population.
下肢创伤性缺损需要强健的软组织来覆盖关键结构并促进愈合。当局部组织不足时，游离组织移植（FTT）往往是必要的。虽然许多文献强调游离皮瓣存活对成功保肢的重要性，但对于额外手术需求或最终截肢的必要性了解有限。我们调查了一家机构的保肢工作，以更好地了解额外手术的需求。
对2014年至2022年在一家一级创伤中心接受下肢保肢手术的所有患者进行回顾性研究。我们的主要临床结果是FTT后二次手术的发生率和指征。
在研究期间共进行了92例下肢游离皮瓣移植手术。患者平均年龄为45岁，大多数为男性。72%的皮瓣为筋膜皮瓣，28%为肌皮瓣。72%的患者在FTT后需要二次手术，每次保肢尝试平均总共进行7次手术。10%的患者最终截肢。体重指数>30、较高的衰弱评分、皮瓣类型和Masquelet技术与随后的截肢显著相关（P分别为0.017、0.024、0.005、0.04）。年龄较大、需要进行骨重建以及受伤至皮瓣覆盖的时间较长与二次手术的需求显著相关（P分别为0.05、<0.001和0.22）。
FTT是保肢的重要组成部分。应告知接受保肢手术的患者二次手术的必要性，因为FTT后这个过程往往并不完整。此外，本研究中确定的风险因素可能会增加随后截肢的可能性。进行全面的术前咨询对于优化该人群的术后过程和预期非常必要。
