Abstract: Free Flap for Limb Salvage Following Oncologic Resection: 12-Year Experience (Plastic Surgery 2014)

Saturday, October 11, 2014: 11:30 AM

Edward I Chang, MD , Plastic Surgery, MD Anderson Cancer Center, Houston, TX

Alexander T Nguyen, MD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Melissa Crosby, MD, FACS , The University of Texas MD Anderson Cancer Center, Houston, TX

Hong Zhang, PhD , Plastic Surgery, MD Anderson Cancer Center, Houston, TX

Jennifer K Hughes, OT , Occupational Therapy, Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX

Julie Moeller, PT , Physical Therapy, Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX

Roman Skoracki, MD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

David W Chang, MD , MD Anderson Cancer Center, Houston, TX

Valerae O Lewis, MD , Orthopedic Surgery, MD Anderson Cancer Center, Houston, TX

Matthew M. Hanasono, MD , Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX

Presentation PDF file

Introduction: While a number of studies have examined free flap salvage for lower extremity trauma, a knowledge gap exists regarding the optimal flap choice for limb reconstruction following oncologic resection, given surgical resection, chemotherapy and radiation. In particular, whether muscle, myocutaneous, or fasciocutaneous flaps have superior outcomes remains unknown.

Methods: Retrospective review of all free flaps performed for upper and lower extremity salvage from 2000-2012.

Results: Overall 220 patients (mean age 51.7 years, mean BMI 27.7 kg/m²) underwent free flap reconstruction for limb salvage (64 upper extremity, 156 lower extremity). Flaps were classified as muscle-only (n=77), myocutaneous (n=67), or fasciocutaneous (n=76). Comorbidities including smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications. However, the presence of osteomyelitis was significantly associated with post-operative infection (OR: 19.5, CI: 3.77-100.64; p=0.0004), wound healing complications (OR: 7.51, CI: 2.21-25.49; p=0.001), and amputation (OR: 4.63, CI: 1.41-15.19; p=0.01). Placement of hardware did not increase complications, although it was associated with nearly 5-times the risk for total flap loss (OR: 4.92, CI: 1.33-18.23; p=0.017).

Fasciocutaneous and myocutaneous flaps were associated with significantly increased risks for hematoma requiring operative evacuation (p=0.02) and an unplanned return to the operating room for microvascular complications (p=0.005). However, they were at lower risk for infection (OR: 0.14, CI: 0.02-0.87; p=0.03) compared to muscle-only flaps. There were 11 total flap losses (5.0%) with fasciocutaneous and myocutaneous flaps at significantly increased risk for flap loss (OR: 2.58, CI: 1.06-6.26; p=0.03). Overall, 190 patients were successfully reconstructed while 30 patients (13.6%) ultimately required amputation.

Conclusions: Free flaps can be performed reliably for limb salvage (86.4%) following tumor extirpation. While fasciocutaneous and myocutaneous flaps were less likely to develop infections, they were at significantly higher risk for take-backs and total flap loss.

25619 Free Flap for Limb Salvage Following Oncologic Resection: 12-Year Experience