The impact of risk factors on the outcome of local perforator flaps used for lower extremity reconstruction

Abstract

Background: The use of local perforator flaps recently arose as an alternative to free flaps for lower extremity reconstruction. In this paper, a single surgeon's experience is discussed in the reconstruction of lower extremity defects with the use of local perforator flaps. Aim: This study speculates the impact of risk factors on local perforator flap outcome and reoperation rates. Study Design: This study is a retrospective study. Materials and Methods: Between December 2013 and December 2020, a total of 51 lower extremity defects were reconstructed using local perforator flaps. Patients were categorized based on risk factors including diabetes mellitus, hypertension, venous insufficiency of the lower extremity, cigarette smoking, and being older than 60 years in addition to the number of risk factors each patient bear. Partial flap necrosis rates, total flap necrosis rates, reoperation rates and their relationship with risk factors were assessed. Results: Out of 51 local perforator-based flaps, no total flap loss and four partial flap loss were encountered. Patients older than 60 years old, hypertensive patients, patients who are smokers, and patients with multiple risk factors had higher partial flap loss rates. In addition, diabetic patients, patients older than 60 years old, and patients bearing multiple risk factors are shown to have higher reoperation rates. Conclusion: Meticulous operative planning and considering the risk factors each patient bear are important in the reconstruction of lower extremity defects. Therefore, risk factors identified in this study must be evaluated during patient selection in the reconstruction of lower extremity defects using local perforator flaps.

Keywords

• perforator flaps
• reconstruction
• risk factors