Risk Factors for Amputation Following Lower Extremity Free Tissue Transfer in a Chronic Wound Population
Vikas Kotha, BS, Elliot Walters, MD, Chris Devulapalli, MD, Christopher E. Attinger, MD, Karen K. Evans, MD.
Georgetown University, Washington, DC, USA.
Purpose: Microsurgical reconstruction via free tissue transfer (FTT) is the last option for closure of nonhealing, lower extremity (LE) wounds. Unfortunately, amputation may be required even if FTT is successful. Thus, assessing amputation risk before reconstruction would help surgeons profile patient risk and direct salvage efforts with outcome-expectations. However, there is a paucity of literature regarding microsurgical outcomes in chronic wound patients. The purpose of this study was to evaluate risk factors for major amputation following LE FTT for closure in a chronic wound population.
Methods: Between April 2011 and January 2018, 135 LE FTT procedures were performed by the corresponding author for soft tissue coverage of nonhealing wounds. We studied the relationship of patient demographics, wound characteristics, and perioperative traits with limb-salvage and ambulation rates.
Results: Overall microsurgical success was 96.3% (130/135) and limb salvage rate was 86.7% (117/135). Comorbidities significant for amputation were diabetes (p=0.009), COPD (p=0.002), ESRD (p=0.007), and PVD (0.02). Only hindfoot wound-location was significant for amputation (p=0.006). Significant perioperative traits significant included elevated platelet count on day of closure (332.8 vs 257.8, p=0.01) gracilis flap-type (p=0.03). Infectious complication was the only postoperative complication predictive of amputation (p=0.007).
Conclusion: By highlighting patient and perioperative traits that increase risk of amputation, these data help clinicians foreshadow the trajectory of wound closure and limb salvage. Furthermore, these results are a first-step to creating protocolized risk-stratification recommendations for patients undergoing LE FTT for complex, nonhealing wounds. To this end, future work will include risk analysis for individual risk factors.
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