Comparing Reconstructive Outcomes in Patients with Gustilo Type IIIB Fractures and Concomitant Arterial Injuries
Joseph A. Ricci, MD1, John T. Stranix, MD2, Z-Hye Lee, MD3, Vishal T. Thanik, MD3, Pierre B. Saadeh, MD3, Jamie P. Levine, MD4.
1Albany Medical Center, Albany, NY, USA, 2New York University, New York, NY, USA, 3New York Univeristy, New York, NY, USA, 4New York Unviersity, New York, NY, USA.
BACKGROUND: The Gustilo Classification serves as a proxy for injury severity, but recent data suggests rising complications with decreasing arterial runoff. This study aims to compare to evaluate different microsurgical anastomosis options based on the number of patent vessels in the lower extremity.
METHODS: A single-center retrospective review of 806 lower extremity free flaps from 1976 - 2016 was performed. Patients with Gustilo IIIB injuries were grouped based on the number of patent vessels in the leg (3-2-1). Patients were compared based on the type of anastomosis performed, evaluating for perioperative complications and flap failures.
RESULTS: Perioperative complications occurred in 111 flaps (27%): 71 takebacks (17%); 45 partial losses (11%); 37 complete losses (9%). Among patients with 3-vessel runoff (61.8%) there was no difference in takebacks or flap loss between those with end-to-end versus end-to-side anastomoses. In 68 patients (18.7%) with 2-vessel runoff, no difference between takebacks or flap loss was noted when comparing any anastomosis (end-to-end into an injured vessel, end-to-end into an uninjured vessel, or end-to-side into an uninjured vessel), although vein grafts were required more often in the end-to-side groups (p <0.01). Finally, in 39 patients (10.7%) with single-vessel runoff, no difference was seen between end-to-end anastomosis into an injured vessel or end-to-side anastomosis into an uninjured vessel in terms of takebacks or flap loss.
CONCLUSIONS: Higher rates of flap failure correlated with decreasing numbers of patent vessels in the leg, but neither type of microvascular anastomosis, nor vessel selection demonstrated any impact on reconstructive outcomes.
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