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Superthin Free Flaps in Obese Patients Undergoing Lower Extremity Reconstruction: Maximizing Function While Minimizing Morbidity
Elena Galvano
*1, Laura K. Tom
2, Grant Kleiber
2, Rajiv Parikh
21Georgetown University School of Medicine, Washington , ; 2Department of Plastic Surgery, MedStar Health Washington Hospital Center, Washington,
Background:Obesity is a public health epidemic. For lower extremity reconstruction, this is challenging as conventional muscle and fasciouctaneous flaps can impair recovery by limiting shoe fit/ambulation and requiring multiple debulking operations. Superthin flaps offer a potential solution, but their role in a predominantly high-BMI population has not been well defined. This study compares outcomes of thin versus conventional flaps in obese patients requiring lower extremity reconstruction.
Methods:A retrospective review was performed of patients undergoing lower-extremity free-flap reconstruction between January 2020 and January 2025. Thin flaps were elevated above the superficial fascia (superthin, ultrathin, or pure skin-perforator), while conventional flaps included muscle and fasciouctaneous flaps. Patient variables, operative details, and complications were compared between cohorts using Welch t-tests and Fisher's exact tests.
Results:A total of 204 patients were included: 74 (36.3%) thin versus 130 (63.7%) conventional flaps. Mean BMI was 33.0 ± 6.8 kg/m
2, with no significant difference between groups (thin 32.2 ± 6.3 vs conventional 33.6 ± 7.0; p=0.20). Demographics and comorbidities were comparable. Thin flaps demonstrated fewer complications (13.0% vs 42.6%, p<0.001) and secondary debulking requirements (1.7% vs 50.0%, p<0.001). Limb salvage (pain-free ambulation) rates were similar (thin 98.6% versus conventional 90.2%, p=0.037). Functional ambulation was achieved, on average, 3.3 months earlier in thin versus conventional flaps.
Conclusions:Thin flaps demonstrated lower rates of complications and secondary debulking procedures compared to conventional flaps. In obese patients undergoing limb salvage, superthin flaps are a safe and effective technique that optimizes functional recovery compared to the standard of care.
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