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Predictive Factors of Successful Salvage Following Takeback in the Setting of Lower Extremity Limb Salvage: Our Institution's 12-Year Experience
Christopher M. Ply
*, Rachel Rohrich, Sami Ferdousian, Ryan Lin, Meghan E. Currin, Richard C. Youn, Christopher E. Attinger, Karen K. Evans, Stephen Baker
Plastic Surgery, Georgetown, Washington,
Background: Microvascular compromise requiring re-exploration is a devastating complication following free tissue transfer (FTT), especially for the chronic lower extremity (LE) wound population at risk for amputation. This study aims to identify factors that predict salvage after LE FTT takeback in the setting of limb salvage.
Methods: A retrospective chart review of LE FTT from February 2011 to June 2024 was performed. Flap takeback was defined as a return to the OR for flap exploration due to viability concerns. Flaps that were salvaged were compared to flaps that were not.
Results: During the study period, 357 LE FTT were performed, of which 26 cases (7.2%) required takeback. A total of 19 (73.1%) flaps salvaged, while 7 (26.9%) were not. Salvaged patients trended to be younger (52.6 ± 12.6 vs. 63.3 ± 12.0, p=0.064) with a lower BMI (28.2 ± 6.7 vs. 33.6 ± 6.8, p=0.083) and greater median hospital length of stay (32, IQR: 10 vs. 23, IQR: 7; p=0.017). There was no significant difference in diabetes (65.4%), peripheral vascular disease (42.3%), and chronic kidney disease (23.1%) between groups. Six patients (24.0%) underwent preoperative vascular intervention (p=1.000). Median wound area tended to be larger in the salvage group (112, IQR: 48 vs 60, IQR: 37; p=0.078). Flap monitoring devices were used more in the salvage group, notably the Cook Doppler (84.2% vs. 57.1%, p=0.293) and ViOptix (52.6% vs. 14.3%, p=0.178). The median time to takeback was 1 day (IQR: 7 days) in the salvage group and 5 days (IQR: 7 days) in the failure group (p=0.280). At a final follow-up of 8.1 (IQR: 9.6) months, 2 patients (7.7%) underwent major limb amputation (p=0.474). Univariate analysis demonstrated that Cook Doppler use was significantly associated with higher odds of flap salvage (OR:11.3, CI: 1.4-92.1, p=0.023).
Conclusion: This is the largest series of LE FTT takeback in the setting of atraumatic limb salvage. Our results reinforce the importance of close monitoring and a low threshold for re-exploration, which may contribute to successful flap salvage.
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