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The Role of Local Flaps in Foot and Ankle Reconstruction: An Assessment of Outcomes Across 206 Patients with Chronic Wounds.
Berger, Lauren E; Spoer, Daisy L; Huffman, Samuel S; Garrett, Richard W; Khayat, Elias; DiBello, John R; Zolper, Elizabeth G; Akbari, Cameron M; Evans, Karen K; Attinger, Christopher E.
Afiliação
  • Berger LE; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia .
  • Spoer DL; Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
  • Huffman SS; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia .
  • Garrett RW; Georgetown University School of Medicine; Washington, District of Columbia.
  • Khayat E; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia .
  • DiBello JR; Georgetown University School of Medicine; Washington, District of Columbia.
  • Zolper EG; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia .
  • Akbari CM; Georgetown University School of Medicine; Washington, District of Columbia.
  • Evans KK; Georgetown University School of Medicine; Washington, District of Columbia.
  • Attinger CE; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia .
Plast Reconstr Surg ; 2024 Jun 24.
Article em En | MEDLINE | ID: mdl-38923878
ABSTRACT

BACKGROUND:

Reconstructive surgery has experienced a paradigm shift in favor of free flaps. Yet, local flaps may be of particular use in foot and ankle reconstruction among comorbid patient populations. Thus, we sought to better characterize long-term outcomes in this setting.

METHODS:

A single-center, retrospective cohort study of patients undergoing local muscle and fasciocutaneous flaps of the foot and ankle from January 2010-November 2022 was performed. Flap were performed on wounds measuring 3x6cm or smaller, and flap selection depended on preoperative vascular assessment, Doppler findings, comorbidity profile, and wound location, depth, and geometry.

RESULTS:

Two-hundred and six patients met inclusion criteria. Median age was 61.0 years (IQR 16.8), and comorbidities included diabetes mellitus (DM; n=149/206, 72.3%) and peripheral arterial disease (PAD; n=105/206, 51.0%). Presentations included chronic, non-healing wounds (n=77/206, 39.1%) or osteomyelitis (n=45/206, 22.8%), and most frequently extended to the bone (n=128/206, 62.1%). Eighty-seven patients (n=87/206, 42.2%) received muscle flaps, while 119 received fasciocutaneous flaps (n=119/206, 57.8%). Six patients (n=6/206, 2.9%) necessitated return to the operating room, with thrombosis occurring in two cases (n=2/206, 1.0%). Flap success rate was 98.1%. By a median follow-up duration of 21.7 months (IQR 39.0), 45 patients (n=45/206, 21.8%) necessitated ipsilateral amputation, 73% (n=145/199) were ambulatory, and two deaths were related to the operated wound (n=2/49, 4.1%). Multivariate analysis revealed positive predictors of complications included DM, end-stage renal disease, and prior histories of venous thromboembolism or smoking.

CONCLUSION:

Local flaps remain a reliable option to reconstruct smaller defects of the foot and ankle in a highly comorbid population.

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article