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Functional Outcomes Following Soft Tissue Reconstruction and Attempted Limb Salvage After Lower Extremity Trauma
Karen E. Burtt, BS, Ido Badash, BA, Hyuma A. Leland, MD, Alexis D. Rounds, BS, Daniel J. Gould, MD, Jennifer Kim, BS, Ketan M. Patel, MD, Joseph N. Carey, MD.
USC Keck School of Medicine, Los Angeles, CA, USA.

PURPOSE: To determine the functional recovery of patients requiring soft tissue reconstruction for lower extremity traumatic injuries.
METHODS: A retrospective chart review was performed on 167 patients at a level 1 trauma center receiving soft tissue reconstruction for lower extremity trauma. Demographics, injury, and perioperative data were recorded. All patients were administered SF-36 and LEFS surveys over the phone.
RESULTS: Out of 150 patients in the database, 50 (33.3% response rate) patients completed the survey. Fractures were 20% closed, 20% Gustilo-Anderson (GA) II, 40% GA-IIIa, and 20% GA-IIIb. Soft tissue reconstruction was local in 62% of patients while 38% of patients required free tissue transfer. Three patients required amputation for chronic osteomyelitis (limb salvage rate=93%). At 18 months follow up, 50% of patients were fully ambulatory, 24% required an assistance device, and 20% were non-ambulatory. Out of 100 possible points, the SF-36 score demonstrated globally decreased scores (Table 1), with particularly low outcomes in physical functioning (35.0), role limitation due to physical health (31.3), and vitality (43.8). Out of 80 possible points, the median LEFS for patients with soft tissue reconstruction was 37 ± 19.5. Based on LEFS, local muscle flaps (30.9) demonstrated worse functional recovery than free flap reconstruction (50.4) (p=0.003).
CONCLUSION: Validated assessment tools demonstrated significant morbidity and loss of function 18 months after injury. In our population, local flaps correlated with worse functional outcomes after reconstruction than free flaps, but this needs to be studied further before wider conclusions can be drawn.
Functional Recovery after Soft Tissue Reconstruction Based on 36-Item Short Form Health Survey
SF-36v2 Sub-scalesMedian ScoreStandard Deviation
Physical functioning35.028.1
Role physical31.336.8
Role emotional66.731.8
Vitality43.826.6
Mental health72.522.9
Social functioning67.533.1
Bodily pain56.330.5
General health57.526.2


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