Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases

Amit Gupta, Chrisovalantis Lakhiani, Beng Hai Lim, Johnathon M. Aho, Adam Goodwin, Ashley Tregaskiss, Michael Lee, Luis Scheker, Michel Saint-Cyr

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. Methods: Retrospective chart review was performed for all patients undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included patient demographic characteristics, timing of reconstruction, location of injury, fracture characteristics, operative interventions, and postoperative complications. Statistical analysis was performed using χ2 and Fisher exact tests. Results: In total, 238 patients underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n = 282). Extremities were repaired within 24 h (75 cases; 27%), in days 2-7 (32 cases; 12%), or after day 7 (172 cases; 62%). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P <.01) and deep infection (RR, 5.3; P <.01), and osteomyelitis (RR, 4.0; P <.01), although not with flap failure (P =.30). Presence of an open fracture was significantly associated with developing superficial (RR, 3.1; P =.01) and deep (RR, 1.9; P <.01) infection, as well as osteomyelitis (RR, 1.6; P <.01). Having a closed fracture did not negatively influence postoperative outcomes. Conclusions: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.

Original languageEnglish (US)
Pages (from-to)1184-1190
Number of pages7
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume68
Issue number9
DOIs
StatePublished - Jan 1 2015

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Upper Extremity
Wounds and Injuries
Open Fractures
Osteomyelitis
Infection
Closed Fractures
Fracture Fixation
Elbow
Veins
Extremities
Demography
Transplants
Safety

Keywords

  • Complications
  • Flap
  • Reconstruction
  • Trauma
  • Upper extremity

ASJC Scopus subject areas

  • Surgery

Cite this

Free tissue transfer to the traumatized upper extremity : Risk factors for postoperative complications in 282 cases. / Gupta, Amit; Lakhiani, Chrisovalantis; Lim, Beng Hai; Aho, Johnathon M.; Goodwin, Adam; Tregaskiss, Ashley; Lee, Michael; Scheker, Luis; Saint-Cyr, Michel.

In: Journal of Plastic, Reconstructive and Aesthetic Surgery, Vol. 68, No. 9, 01.01.2015, p. 1184-1190.

Research output: Contribution to journalArticle

Gupta, Amit ; Lakhiani, Chrisovalantis ; Lim, Beng Hai ; Aho, Johnathon M. ; Goodwin, Adam ; Tregaskiss, Ashley ; Lee, Michael ; Scheker, Luis ; Saint-Cyr, Michel. / Free tissue transfer to the traumatized upper extremity : Risk factors for postoperative complications in 282 cases. In: Journal of Plastic, Reconstructive and Aesthetic Surgery. 2015 ; Vol. 68, No. 9. pp. 1184-1190.
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abstract = "Background: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. Methods: Retrospective chart review was performed for all patients undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included patient demographic characteristics, timing of reconstruction, location of injury, fracture characteristics, operative interventions, and postoperative complications. Statistical analysis was performed using χ2 and Fisher exact tests. Results: In total, 238 patients underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n = 282). Extremities were repaired within 24 h (75 cases; 27{\%}), in days 2-7 (32 cases; 12{\%}), or after day 7 (172 cases; 62{\%}). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P <.01) and deep infection (RR, 5.3; P <.01), and osteomyelitis (RR, 4.0; P <.01), although not with flap failure (P =.30). Presence of an open fracture was significantly associated with developing superficial (RR, 3.1; P =.01) and deep (RR, 1.9; P <.01) infection, as well as osteomyelitis (RR, 1.6; P <.01). Having a closed fracture did not negatively influence postoperative outcomes. Conclusions: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.",
keywords = "Complications, Flap, Reconstruction, Trauma, Upper extremity",
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T1 - Free tissue transfer to the traumatized upper extremity

T2 - Risk factors for postoperative complications in 282 cases

AU - Gupta, Amit

AU - Lakhiani, Chrisovalantis

AU - Lim, Beng Hai

AU - Aho, Johnathon M.

AU - Goodwin, Adam

AU - Tregaskiss, Ashley

AU - Lee, Michael

AU - Scheker, Luis

AU - Saint-Cyr, Michel

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. Methods: Retrospective chart review was performed for all patients undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included patient demographic characteristics, timing of reconstruction, location of injury, fracture characteristics, operative interventions, and postoperative complications. Statistical analysis was performed using χ2 and Fisher exact tests. Results: In total, 238 patients underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n = 282). Extremities were repaired within 24 h (75 cases; 27%), in days 2-7 (32 cases; 12%), or after day 7 (172 cases; 62%). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P <.01) and deep infection (RR, 5.3; P <.01), and osteomyelitis (RR, 4.0; P <.01), although not with flap failure (P =.30). Presence of an open fracture was significantly associated with developing superficial (RR, 3.1; P =.01) and deep (RR, 1.9; P <.01) infection, as well as osteomyelitis (RR, 1.6; P <.01). Having a closed fracture did not negatively influence postoperative outcomes. Conclusions: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.

AB - Background: Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. Methods: Retrospective chart review was performed for all patients undergoing free tissue transfer for upper extremity reconstruction from 1976 to 2001. Data collected included patient demographic characteristics, timing of reconstruction, location of injury, fracture characteristics, operative interventions, and postoperative complications. Statistical analysis was performed using χ2 and Fisher exact tests. Results: In total, 238 patients underwent 285 free tissue transfers and met inclusion criteria, from which 3 were excluded because of inadequate information (n = 282). Extremities were repaired within 24 h (75 cases; 27%), in days 2-7 (32 cases; 12%), or after day 7 (172 cases; 62%). Timing of reconstruction did not significantly affect postoperative outcomes. Proximal location of injury was significantly associated with superficial (relative risk [RR], 6.5; P <.01) and deep infection (RR, 5.3; P <.01), and osteomyelitis (RR, 4.0; P <.01), although not with flap failure (P =.30). Presence of an open fracture was significantly associated with developing superficial (RR, 3.1; P =.01) and deep (RR, 1.9; P <.01) infection, as well as osteomyelitis (RR, 1.6; P <.01). Having a closed fracture did not negatively influence postoperative outcomes. Conclusions: This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.

KW - Complications

KW - Flap

KW - Reconstruction

KW - Trauma

KW - Upper extremity

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