Incidence of Major Arterial Abnormality in Patients with Wound Dehiscence after Lower Extremity Orthopedic Procedures.
Incidence of Major Arterial Abnormality in Patients with Wound Dehiscence after Lower Extremity Orthopedic Procedures.
- 2020
BACKGROUND: Surgical dehiscence can occur after lower extremity orthopedic procedures. Underlying vascular aberrancy and localized ischemia contribute to chronic wound development requiring advanced techniques such as free tissue transfer. Localized vascular abnormality is an underrecognized contributing factor to such dehiscence. The authors reviewed their lower extremity free tissue transfer experience in this population to analyze the incidence of arterial abnormality and outcomes. CONCLUSIONS: The high incidence of arterial abnormality in this population highlights the importance of expedient multidisciplinary care, including vascular and plastic surgery. Diagnostic angiography is important for identifying major arterial abnormality and the need for free tissue transfer for definitive coverage. METHODS: The authors conducted a retrospective review of 64 lower extremity free tissue transfers performed for chronic wounds after orthopedic procedures from 2011 to 2018. The primary outcome was major arterial abnormality as identified on angiography. Secondary outcomes were flap success, limb salvage, and ambulation status. RESULTS: The median age was 58 years, and 44 were men (69 percent). Comorbidities included osteomyelitis (77 percent), diabetes (39 percent), and peripheral vascular disease (17 percent). The incidence of arterial abnormality on angiography was 47 percent. Defect location correlated with angiosome of arterial abnormality in 53 percent. The flap success rate was 92 percent. Limb salvage and ambulation rates were 89 and 89 percent, respectively, at an average follow-up of 17.6 months. Men demonstrated an increased rate of limb salvage (p = 0.026). Diabetes (p = 0.012), arterial abnormality (p = 0.044), and arterial flap complication (p = 0.010) correlated with amputation.
English
0032-1052
00006534-202012000-00031 [pii] 10.1097/PRS.0000000000007361 [doi]
*Arterial Occlusive Diseases/ep [Epidemiology]
*Free Tissue Flaps/tr [Transplantation]
*Orthopedic Procedures/ae [Adverse Effects]
*Surgical Wound Dehiscence/su [Surgery]
Aged
Amputation/sn [Statistics & Numerical Data]
Angiography/sn [Statistics & Numerical Data]
Arterial Occlusive Diseases/et [Etiology]
Arterial Occlusive Diseases/su [Surgery]
Arteries/dg [Diagnostic Imaging]
Arteries/su [Surgery]
Comorbidity
Female
Follow-Up Studies
Humans
Incidence
Limb Salvage/sn [Statistics & Numerical Data]
Lower Extremity/bs [Blood Supply]
Lower Extremity/su [Surgery]
Male
Middle Aged
Peripheral Vascular Diseases/ep [Epidemiology]
Retrospective Studies
Surgical Wound Dehiscence/et [Etiology]
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Podiatric Surgery
Journal Article
BACKGROUND: Surgical dehiscence can occur after lower extremity orthopedic procedures. Underlying vascular aberrancy and localized ischemia contribute to chronic wound development requiring advanced techniques such as free tissue transfer. Localized vascular abnormality is an underrecognized contributing factor to such dehiscence. The authors reviewed their lower extremity free tissue transfer experience in this population to analyze the incidence of arterial abnormality and outcomes. CONCLUSIONS: The high incidence of arterial abnormality in this population highlights the importance of expedient multidisciplinary care, including vascular and plastic surgery. Diagnostic angiography is important for identifying major arterial abnormality and the need for free tissue transfer for definitive coverage. METHODS: The authors conducted a retrospective review of 64 lower extremity free tissue transfers performed for chronic wounds after orthopedic procedures from 2011 to 2018. The primary outcome was major arterial abnormality as identified on angiography. Secondary outcomes were flap success, limb salvage, and ambulation status. RESULTS: The median age was 58 years, and 44 were men (69 percent). Comorbidities included osteomyelitis (77 percent), diabetes (39 percent), and peripheral vascular disease (17 percent). The incidence of arterial abnormality on angiography was 47 percent. Defect location correlated with angiosome of arterial abnormality in 53 percent. The flap success rate was 92 percent. Limb salvage and ambulation rates were 89 and 89 percent, respectively, at an average follow-up of 17.6 months. Men demonstrated an increased rate of limb salvage (p = 0.026). Diabetes (p = 0.012), arterial abnormality (p = 0.044), and arterial flap complication (p = 0.010) correlated with amputation.
English
0032-1052
00006534-202012000-00031 [pii] 10.1097/PRS.0000000000007361 [doi]
*Arterial Occlusive Diseases/ep [Epidemiology]
*Free Tissue Flaps/tr [Transplantation]
*Orthopedic Procedures/ae [Adverse Effects]
*Surgical Wound Dehiscence/su [Surgery]
Aged
Amputation/sn [Statistics & Numerical Data]
Angiography/sn [Statistics & Numerical Data]
Arterial Occlusive Diseases/et [Etiology]
Arterial Occlusive Diseases/su [Surgery]
Arteries/dg [Diagnostic Imaging]
Arteries/su [Surgery]
Comorbidity
Female
Follow-Up Studies
Humans
Incidence
Limb Salvage/sn [Statistics & Numerical Data]
Lower Extremity/bs [Blood Supply]
Lower Extremity/su [Surgery]
Male
Middle Aged
Peripheral Vascular Diseases/ep [Epidemiology]
Retrospective Studies
Surgical Wound Dehiscence/et [Etiology]
MedStar Washington Hospital Center
Surgery/Plastic Surgery
Surgery/Podiatric Surgery
Journal Article