Back to 2014 Annual Meeting Abstracts

BACKGROUND:
Many patients with successful salvage have secondary postoperative functional and aesthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to purely aesthetic concerns involving color, contour and texture match. Multiple tools are currently available to optimize the overall outcome of limb salvage patients. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, aesthetic refinements of lower extremity free flaps and to review current techniques for revision.
METHODS:
All patients undergoing lower extremity soft tissue coverage for limb salvage procedures between January 2007 and June 2013 at a single academic teaching hospital were included in the analysis. A detailed chart review was performed examining past medical and surgical characteristics, operative details, postoperative follow up. Patients who underwent secondary refinements for lower extremity free flaps were compared to patients not undergoing secondary procedures.
RESULTS:
During the study period, 168 free tissue transfers were performed for lower extremity limb salvage. Eight patients (8, 4.7%) experienced failed free tissue transfer, and ultimately 9 (5.3%) patients underwent limb amputation. Of the final study cohort (152 patients), 31 (20.4%) patients underwent secondary, aesthetic revisions. The most common revision was complex soft tissue rearrangement or surgical flap debulking/direct excision (87.5% of flaps), followed by scar revision (12.5%), suction assisted lipectomy (3.1%), LASER scar revision (3.1%), and tissue expansion followed by local tissue rearrangement (3.1%). Few differences in demographic or operative characteristics were noted, Although defects in revision patients trended to be be located below the ankle (p=0.1).
CONCLUSIONS:
This study demonstrates that although the primary goal of limb salvage is often achieved, a significant portion of patients desire secondary revisions following the initial procedure. This is especially true of patients with free tissue transfer below the ankle. Multiple tools are at the disposal of the plastic surgeon to aid a patient in their process of recovery. In many patients, an aesthetic consideration should not be of secondary concern, but should be viewed as part of the ultimate reconstructive algorithm for lower extremity limb salvage.