Northeastern Society of Plastic Surgeons

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Factors Correlated to Delays to Free Flaps in Lower Extremity Free Flap Reconstructions
Kristina L. Khaw*1, Monica Morgenstern2, Steven Bonawitz2
1Cooper Medical School of Rowan University, Plainsboro, NJ; 2Cooper University Healthcare, Camden, NJ

Background: Lower extremity flap reconstructions are often due to traumatic injuries requiring emergency surgeries. Studies found that delays in operating increase morbidity, mortality, and length of hospital stay. There are limited studies assessing disparities in delays to flap surgery. This study aims to identify factors for delays in surgery in lower extremity reconstruction procedures. Methods: In a single center from January 2015 - January 2024, 80 patients who underwent a lower extremity flap reconstruction and remained inpatient until their reconstruction operation were identified. The time to surgery from admission, time to consult, and time from consult to surgery were collected. Delays to flap were defined as >14 days from admission to surgery. Demographics, substance use history, Charlson Comorbidity Index (CCI), and Trauma Severity Score (TSS) were collected. A MANOVA was used for quantitative variables while a Chi square test was used for categorical variables. Results: In the delay to flap (DF) cohort (n=40) and no delay to flap (ND) cohort (n=40), minority patients were more likely to experience delays to flap (DF:55%, ND:15%, p=0.004). Surprisingly, there were no correlations with CCI, TSS, marijuana use, or illegal drug use. Patients with no delay were more likely to have a history of tobacco use (DF:45%, ND:72.5%, p=0.036). Delays to flap patients were correlated with a significantly longer time to consult (DF:8.1d, ND:2.3d, p<0.001) and time to surgery from consult (18.3d, 5.8d, p<0.001). There was a significant correlation between delays to flap and documented deterioration in conditions such as infection (DF:32.5%, ND:7.5%, p=0.012). Conclusion: Patients who experience delays to flap are more likely to be a minority, have deterioration of condition, and delayed time to consult. This suggests that there may be a disparity of infection management, susceptibility to infection, and flap recognition that lead to delays to lower extremity reconstruction. Additional larger studies analyzing factors correlation with complications may be helpful.


Table 1. Demographics and Preoperative Factors of Lower Extremity Reconstruction Patients
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