Plastic Surgery Research Council

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Limb Salvage Rates and Functional Outcomes Using a Longitudinal Slit Arteriotomy End to Side Anastomosis for Limb threatening Defects in a High-risk, Comorbid Patient Population
Cara K. Black, BA1, Kenneth L. Fan, MD1, Kyle Luvisa, BS2, Vikas S. Kotha, BS1, Michael V. Defazio, MD3, Karen Evans, MD, FACS1.
1MedStar Georgetown University Hospital, Department of Plastic and Reconstructive Surgery, Washington, DC, USA, 2Georgetown University School of Medicine, Washington, DC, USA, 3MD Anderson Cancer Center, Houston, TX, USA.

Background: Limb salvage techniques using free tissue transfer (FTT) in patients with chronic wounds due to long standing osteomyelitis, diabetes and peripheral vascular disease (PVD) are technically challenging.  The Longitudinal Slit Arteriotomy End to Side Anastomosis (LS-ETSA) is our preferred technique because it is the least invasive arteriotomy for diseased recipient arteries. We reviewed our highly comorbid patients who underwent FTT with this technique to understand the success rates, overall outcomes and long term limb salvage rates.   
Methods: A retrospective review was performed to analyze outcomes of FTT using (LS-ETSA)  between April 2012 and August 2018 by the senior surgeon.
Results: 115 free flap patients were obtained(27.0% females, 65.2% males). Demographics were: average age 55 years old, BMI 29.2 kg/m2, chronic wound infection(83.5%), hypertension(60.9%), tobacco use(46.1%), PVD(44.3%), and DMII(38.3%), hypercoagulability(35.7%), arterial calcifications(17.4%). Overall flap success was 91.3%. Overall complication rate was 25.2% with 16.5% as major complications (hematoma evacuation, wound dehiscence repair) and 8.7% as minor complications (distal flap necrosis, infections).  5.21% required anastomotic revision and 23.4% required reoperation in the perioperative period. The only factor which was significant for complications was arterial calcification(p 0.0440). Smoking, DM, hypercoagulability, PVD were not significant for flap failure. 17.3% eventually required amputation of the reconstructed lower extremity. 90.0% were ambulating at a mean follow up time of 1.45 years.
Conclusions: We present the largest series of LS-ETSA for patients undergoing FTT for limb threatening defects in the compromised host. Overall flap success, limb salvage rates and functional outcomes are high using this technique.


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