Long Term Outcomes Of Lower Extremity Salvage With Free Tissue Transfer In The Chronic Wound Population
Elizabeth G. Zolper, BS1, Jenna C. Bekeny, BA1, Vikas S. Kotha, BS2, Nicole C. Episalla, BA3, Christopher E. Attinger, MD1, Kenneth L. Fan, MD1, Karen K. Evans, MD1.
1MedStar Georgetown University Hospital, Washington, DC, USA, 2George Washington School of Medicine, Washington, DC, USA, 3Georgetown University School of Medicine, Washington, DC, USA.
Purpose: Prior to advances in microsurgery, chronic lower extremity wounds required amputation, known to be associated with five-year mortality rates as high as 70%.1 Advanced limb salvage techniques are possible. However, there remains a paucity of literature on long term mortality benefit of this approach. The purpose of this study is to examine long term limb salvage rates and mortality of LE FTT at a single institution.
Methods: Retrospective review of lower extremity FTT at our institution from 2011-2019 was performed. Data collected included demographics, comorbidities, and FTT characteristics. Mortality was determined from obituary data and chart review. Primary outcomes of limb salvage and mortality were estimated using Kaplan-Meier analyses.
Results: Of 144 FTT procedures performed for lower extremity salvage in the chronic wound population, 142 occurred in unique limbs and in 139 unique patients. Average age was 56.4±14.0 years. Average BMI was 28.5±5.9 kg/m2. Mean Charlson Comorbidity Index was 3.2±2.3. Common comorbidities included osteomyelitis 62.4% and diabetes 45.1%. Most common flap types were anterolateral thigh or anteromedial thigh 51.1%, vastus lateralis 28.4%, and gracilis 6.4%. Flap survival occurred in 93.8%. Rate of ambulation was 88.5%. Estimated five-year limb salvage rate was 73.6% while five-year mortality was 17.1% (Figure 1).
Conclusions: We present the largest long-term study of FTT for lower extremity salvage in the chronic wound population to date. Our data demonstrates that a high rate of limb salvage is sustained over time. In the minority of cases with failure of salvage, progression to amputation most often occurs within the first year. Long term mortality is also excellent supporting an aggressive approach to limb salvage in this highly comorbid population.
Figure 1. Kaplan-Meier survival estimates for limb salvage and mortality after LE FTT at our institution.
1. Stern JR, Wong CK, Yerovinkina M, et al. A Meta-analysis of Long-term Mortality and Associated Risk Factors following Lower Extremity Amputation. Ann Vasc Surg. 2017;42:322-327.
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