Plastic Surgery Research Council
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Presenter: James Economides, BS
Co-Authors: Marshall E; Patel KM; Fan KL; Attinger C; Evans KK

Background: Lower extremity soft tissue defects pose a challenging problem to patients with co-morbidities such as diabetes mellitus and peripheral vascular disease. Reconstruction with tissue transfer offers an effective alternative to amputation in this patient population. Although abundant with data on success and complication rates, to date the literature has not focused on assessing patient-centered outcomes of these reconstructive procedures.

Methods: Relevant studies were identified using specific search strategies on PubMed and Ovid. Systematic review was performed on English articles of lower extremity tissue transfer discussing patient-centered outcomes. These include data on patients with comorbid conditions as diabetes mellitus, peripheral vascular disease, or end stage renal disease. Patient centered outcomes include complication rates and functional outcomes as weight bearing, time to ambulation, patient satisfaction measures, or quality of life measures. Single case reports or articles reporting data on wounds sustained from trauma were excluded.

Results: In total, 318 articles were identified. After applying inclusion and exclusion criteria, 51 articles reporting data on 1292 total flaps remained for inclusion in this review. The weighted mean rate of flap success was 86%. Ambulation outcomes were reported by 35 articles with a weighted mean rate of post-operative ambulation of 77.4%. Mean time to ambulation was 12.4 months (range: 9-22), with 33.1 month follow up. Quality of life and patient satisfaction outcomes were infrequently and inconsistently reported in the literature. Main complications include delayed wound healing, wound recurrence, infection, flap loss, amputation, and death.

Conclusion: There is a dearth of patient-centered outcomes for lower extremity flap reconstruction currently in the literature. Current studies utilize multiple and incongruent methods of assessing patient centered outcomes. A standardized method should be employed to better understand the effectiveness of these procedures.

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