Patient-reported Outcomes after Local Flap Coverage Versus Amputation for Complex Lower Extremity Trauma

Abstract

PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. RESULTS: Surveys were completed by 65 patients (response rate 60.7%). The mean time of survey after flap reconstruction was 3.2 years. Recent trauma (within 90 days) was the most common indication for local flap coverage (n=26). Flap complications included wound dehiscence (n=8) and infection (n=4). Other flap complications included partial flap necrosis (n=12), total flap necrosis (n=2), and secondary amputation (n=4). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared to fasciocutaneous flaps (p=0.021 and p=0.022 respectively). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS (p=0.017), SF-36 physical functioning (p=0.033), and health change (p=0.050) scores than amputation patients. CONCLUSION: PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. Patients who underwent fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. This data suggests that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.