000			04772nam a22007217a 4500
008			210217s20212021 xxu||||| |||| 00| 0 eng d
022			_a0032-1052
024			_a00006534-202102000-00035 [pii]
024			_a10.1097/PRS.0000000000007575 [doi]
040			_aOvid MEDLINE(R)
099			_a33235049
245			_aDay-of-Free Tissue Transfer Qualitative Cultures Do Not Predict Limb Salvage Outcomes.
251			_aPlastic & Reconstructive Surgery. 147(2):492-499, 2021 02 01.
252			_aPlast Reconstr Surg. 147(2):492-499, 2021 02 01.
252			_zPlast Reconstr Surg. 147(2):492-499, 2021 Feb 01.
253			_aPlastic and reconstructive surgery
260			_c2021
260			_fFY2021
265			_sppublish
266			_d2021-02-17
268			_aPlastic & Reconstructive Surgery. 147(2):492-499, 2021 Feb 01.
520			_aBACKGROUND: Successful free tissue transfer is critical for lower extremity salvage in the chronic wound population. The rates of lower extremity free tissue transfer success lag behind those for other anatomical sites. The aim of this study was to evaluate whether positive qualitative day-of-free tissue transfer cultures or pathogen virulence negatively impacts short- and long-term outcomes of lower extremity free tissue transfer.
520			_aCLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. Copyright (c) 2020 by the American Society of Plastic Surgeons.
520			_aCONCLUSIONS: Positive day-of-free tissue transfer cultures, regardless of pathogen, had limited predictive value for short- and long-term outcomes of free tissue transfer in the authors' cohort. These findings call for a broader multicenter prospective analysis and consideration of health care-associated infections and their impact on limb salvage outcomes.
520			_aMETHODS: Between April of 2011 and January of 2018, 105 lower extremity free tissue transfer procedures were performed. Growth level and speciation were identified from qualitative cultures taken during free tissue transfer. The relationship between demographics, comorbidities, culture data, postoperative infection, free tissue transfer survival, and long-term limb salvage was examined using logistic regression.
520			_aRESULTS: The median Charlson Comorbidity Index was 3. Intraoperative free tissue transfer cultures were positive in 39.1 percent. Flap survival was 93.3 percent. Postoperative infection developed in 12.4 percent. The limb salvage rate was 81.0 percent. Positive culture was not significant for flap survival, postoperative infection, or amputation. Cultures positive for Enterococcus species had a significant relationship with flap success (OR, 0.08; p = 0.01) and amputation (OR, 7.32; p = 0.04). Insufficient antimicrobial coverage had a significant relationship with postoperative infection (OR, 6.56; p = 0.01) despite the lack of pathogen concordance. On multivariate analysis, postoperative infection (OR, 12.85; p < 0.01) and Charlson Comorbidity Index were predictive of eventual amputation (OR, 1.44; p = 0.01).
546			_aEnglish
650			_a*Bacteriological Techniques/sn [Statistics & Numerical Data]
650			_a*Free Tissue Flaps/tr [Transplantation]
650			_a*Limb Salvage/mt [Methods]
650			_a*Lower Extremity/in [Injuries]
650			_a*Surgical Wound Infection/ep [Epidemiology]
650			_aAged
650			_aAmputation/sn [Statistics & Numerical Data]
650			_aAnti-Bacterial Agents/tu [Therapeutic Use]
650			_aAntibiotic Prophylaxis/mt [Methods]
650			_aAntibiotic Prophylaxis/sn [Statistics & Numerical Data]
650			_aChronic Disease/th [Therapy]
650			_aFemale
650			_aFree Tissue Flaps/mi [Microbiology]
650			_aGraft Survival
650			_aHumans
650			_aLimb Salvage/ae [Adverse Effects]
650			_aLower Extremity/mi [Microbiology]
650			_aLower Extremity/su [Surgery]
650			_aMale
650			_aMiddle Aged
650			_aPredictive Value of Tests
650			_aRetrospective Studies
650			_aRisk Assessment/mt [Methods]
650			_aRisk Assessment/sn [Statistics & Numerical Data]
650			_aSurgical Wound Infection/mi [Microbiology]
650			_aSurgical Wound Infection/pc [Prevention & Control]
650			_aTreatment Outcome
651			_aMedStar Washington Hospital Center
656			_aSurgery/Plastic Surgery
657			_aJournal Article
700			_aFan, Kenneth L
700			_aWalters, Elliot T
790			_aBekeny JC, Evans KK, Fan KL, Fortman E, Kotha VS, Ormiston LD, Walters ET, Zolper EG
856			_uhttps://dx.doi.org/10.1097/PRS.0000000000007575 _zhttps://dx.doi.org/10.1097/PRS.0000000000007575
942			_cART _dArticle
999			_c6096 _d6096