Surgical Management of Lower Extremity Wounds in the Solid Organ Transplant Patient Population: Surgeon Beware. 

 -  2022 
<br/><br/> APPROACH: An eight-year retrospective review was conducted for all SOT recipients with LE wounds necessitating surgical management at our tertiary limb salvage center. Outcomes of interest included wound healing, surgical treatment, progression to amputation, and amputation level. Factors contributing to amputation progression were analyzed. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.  CONCLUSIONS: This is the first comprehensive analysis of LE wounds in the transplant population. Our analysis indicates high rates of failed minor amputation, and frequent progression to major amputation in SOT patients. Preexisting comorbidities and immunosuppressive regimens complicate limb salvage, therefore further research is warranted to optimize surgical LE wound management in this population.  INNOVATION: To identify the outcomes of patients undergoing surgical management for lower extremity wounds after SOT and elucidate clinical factors that impact the rate of limb salvage.  OBJECTIVE: To evaluate our institutional outcomes of surgical management of lower extremity wounds in the solid organ transplant recipient population.  RESULTS: 64 SOT recipients underwent surgical management for their LE wounds between 2010-2018. Median number of surgeries per patient was 5 (IQR 2,8); 47/64 patients (73.4%) underwent amputation, and 17/64 patients (26.6%) underwent non-amputation surgical management. In the amputation group, the majority of primary amputations were minor (42/47, 89.4%); 24/42 (57.1%) patients progressed to a higher amputation level, 16/42 (38.1%) healed after their index procedure, and 2/42 (4.8%) were lost to follow up (LTFU) after their primary minor amputation. 5/47 (10.6%) of the patients undergoing amputations required primary below-knee amputations (BKA). In the non-amputation group, 15/17 (88.2%) healed, 1/17 (5.9%) expired, and 1/17 (5.9%) was LTFU. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>2162-1918 
<br/><br/><label>Standard No.: </label>10.1089/wound.2020.1380 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Limb Salvage<br/>*Lower Extremity/su [Surgery]<br/>*Organ Transplantation<br/>*Wound Healing<br/>*Wounds and Injuries/th [Therapy]<br/>Amputation<br/>Female<br/>Humans<br/>Male<br/>Middle Aged<br/>Organ Transplantation/ae [Adverse Effects]<br/>Retrospective Studies
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Surgery/Plastic Surgery<br/>Surgery/Podiatric Surgery
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article