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

MedStar author(s):
Citation: Advances in Wound Care. 11(1):10-18, 2022 01.PMID: 33487096Institution: MedStar Washington Hospital CenterDepartment: Surgery/Plastic Surgery | Surgery/Podiatric SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Limb Salvage | *Lower Extremity/su [Surgery] | *Organ Transplantation | *Wound Healing | *Wounds and Injuries/th [Therapy] | Amputation | Female | Humans | Male | Middle Aged | Organ Transplantation/ae [Adverse Effects] | Retrospective StudiesYear: 2022ISSN:
  • 2162-1918
Name of journal: Advances in wound careAbstract: 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.All authors: Abrams PL, Abu El Hawa AA, Attinger C, Bekeny JC, Bovill JD, Dekker PK, Evans KK, Fan KL, Kennedy CJ, Steinberg JS, Tirrell AR, Walters ET, Zolper EGOriginally published: Advances in Wound Care. 2021 Jan 23Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-02-17
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Journal Article MedStar Authors Catalog Article 33487096 Available 33487096

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.

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