Erschienen in:
01.03.2016 | Reconstructive Oncology
Optimization of Free-Flap Limb Salvage and Maximizing Function and Quality of Life Following Oncologic Resection: 12-Year Experience
verfasst von:
Edward I. Chang, MD, FACS, Alexander T. Nguyen, MD, FACS, Jennifer K. Hughes, OTR, Julie Moeller, PT, Hong Zhang, PhD, Melissa A. Crosby, MD, FACS, Roman J. Skoracki, MD, FACS, David W. Chang, MD, Valerae O. Lewis, MD, Matthew M. Hanasono, MD, FACS
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 3/2016
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Abstract
Introduction
A knowledge gap exists regarding factors to optimize limb salvage and function following oncologic resection.
Methods
We conducted a retrospective review of all free flaps performed for upper extremity (UE) and lower extremity (LE) salvage from 2000 to 2012.
Results
Overall, 220 patients underwent free-flap reconstruction for limb salvage (UE: 64, and LE: 156). Flaps were classified as muscle-only (n = 77), myocutaneous (MC; n = 67), or fasciocutaneous (FC; n = 76). Smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications, while osteomyelitis significantly increased the risk of infection (odds ratio [OR] 19.5, confidence interval [95 % CI] 3.77–100.64; p = 0.0004), wound healing complications (OR 7.51, 95 % CI 2.21–25.49; p = 0.001), and amputation (OR 4.63, 95 % CI 1.41–15.19; p = 0.01). Hardware increased the risk for flap loss (OR 4.92, 95 % CI 1.33–18.23; p = 0.017). MC and FC flaps had increased risks for hematoma (p = 0.02) and reoperation for microvascular complications (p = 0.005) but were at lower risk for infection (OR 0.14, 95 % CI 0.02–0.87; p = 0.03) compared with muscle-only flaps. There were a total of seven total flap losses (3.2 %), with significantly increased risks for MC/FC flaps (OR 2.58, 95 % CI 1.06–6.26; p = 0.03). For LE, 103 patients (66.3 %) were fully ambulatory, while 23 (14.7 %) were ambulatory with assistance (mean Musculoskeletal Tumor Society score (MSTS) 80.2, and Karnofsky score 84.0). For UE, 49 patients (76.6 %) were able to perform their activities of daily living independently (mean MSTS 80.2, and Karnofsky score 86.0). Overall, 190 patients (86.4 %) were successfully salvaged.
Conclusions
Free flaps can be performed reliably for limb salvage following tumor extirpation. While MC/FC flaps demonstrated improved postoperative function, they were at significantly higher risk for take-backs and total flap loss.