Download PDF
J Reconstr Microsurg 2013; 29(05): 307-316
DOI: 10.1055/s-0033-1333624
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Systematic Review of Patient-Centered Outcomes Following Lower Extremity Flap Reconstruction in Comorbid Patients

James M. Economides
1   School of Medicine, Georgetown University Hospital, Washington, District of Columbia
,
Ketan M. Patel
2   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Karen Kim Evans
2   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Elizabeth Marshall
3   Department of Plastic Surgery, The George Washington University Hospital, Washington, District of Columbia
,
Christopher E. Attinger
2   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
Further Information

Publication History

04 November 2012

30 November 2012

Publication Date:
07 February 2013 (online)

    Permissions and Reprints

Abstract

Background Lower extremity soft tissue defects pose a challenging problem to patients with comorbidities. Reconstruction with tissue transfer offers an effective alternative to amputation in this population. Although abundant with data on success and complication rates, the literature has not focused on assessing patient-centered outcomes of these reconstructive procedures.

Methods A systematic review was performed by searching an electronic database for relevant studies. The full text of relevant articles was retrieved and the reference lists of those articles reviewed. Single case reports or articles reporting data on wounds sustained from trauma were excluded.

Results In total, 318 articles were identified. After applying inclusion and exclusion criteria, 50 articles reporting data on 1,079 flaps remained for inclusion in this review. Ambulation outcomes were reported by 35 articles with a weighted mean rate of postoperative ambulation of 77.4%. Postoperative time to ambulation ranged from an average of 9 months to 22 months. Quality of life and patient satisfaction outcomes were infrequently and inconsistently reported in the literature.

Conclusion There is a dearth of patient-centered outcomes for lower extremity flap reconstruction currently in the literature. A standardized method to assessing patient-centered outcomes should be employed to better understand the effectiveness of these procedures.

Level of Evidence III Therapeutic

Keywords

lower extremity reconstruction - tissue transfer procedures - patient-reported outcomes
 

  • References

  • 1 Ramsey SD, Newton K, Blough D , et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 1999; 22: 382-387
    CrossrefPubMedGoogle Scholar
  • 2 Ikonen TS, Sund R, Venermo M, Winell K. Fewer major amputations among individuals with diabetes in Finland in 1997-2007: a population-based study. Diabetes Care 2010; 33: 2598-2603
    CrossrefPubMedGoogle Scholar
  • 3 Lavery LA, Hunt NA, Ndip A, Lavery DC, Van Houtum W, Boulton AJ. Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care 2010; 33: 2365-2369
    CrossrefPubMedGoogle Scholar
  • 4 Huse DM, Oster G, Killen AR, Lacey MJ, Colditz GA. The economic costs of non-insulin-dependent diabetes mellitus. JAMA 1989; 262: 2708-2713
    CrossrefPubMedGoogle Scholar
  • 5 Ecker ML, Jacobs BS. Lower extremity amputation in diabetic patients. Diabetes 1970; 19: 189-195
    CrossrefPubMedGoogle Scholar
  • 6 Goldner MG. The fate of the second leg in the diabetic amputee. Diabetes 1960; 9: 100-103
    CrossrefPubMedGoogle Scholar
  • 7 Kucan JO, Robson MC. Diabetic foot infections: fate of the contralateral foot. Plast Reconstr Surg 1986; 77: 439-441
    PubMedGoogle Scholar
  • 8 Bosse MJ, MacKenzie EJ, Kellam JF , et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med 2002; 347: 1924-1931
    CrossrefPubMedGoogle Scholar
  • 9 Oishi SN, Levin LS, Pederson WC. Microsurgical management of extremity wounds in diabetics with peripheral vascular disease. Plast Reconstr Surg 1993; 92: 485-492
    PubMedGoogle Scholar
  • 10 Ozkan O, Coşkunfirat OK, Ozgentaş HE. Reliability of free-flap coverage in diabetic foot ulcers. Microsurgery 2005; 25: 107-112
    Google Scholar
  • 11 Quiñones-Baldrich WJ, Kashyap VS, Taw MB , et al. Combined revascularization and microvascular free tissue transfer for limb salvage: a six-year experience. Ann Vasc Surg 2000; 14: 99-104
    CrossrefPubMedGoogle Scholar
  • 12 Randon C, Jacobs B, De Ryck F, Van Landuyt K, Vermassen F. A 15-year experience with combined vascular reconstruction and free flap transfer for limb-salvage. Eur J Vasc Endovasc Surg 2009; 38: 338-345
    CrossrefPubMedGoogle Scholar
  • 13 Randon C, Vermassen F, Jacobs B, De Ryck F, Van Landuyt K, Taes Y. Outcome of arterial reconstruction and free-flap coverage in diabetic foot ulcers: long-term results. World J Surg 2010; 34: 177-184
    CrossrefPubMedGoogle Scholar
  • 14 Tukiainen E, Kallio M, Lepäntalo M. Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Long-term outcome. Ann Surg 2006; 244: 949-957 , discussion 957–958
    CrossrefPubMedGoogle Scholar
  • 15 Verhelle NA, Lemaire V, Nelissen X, Vandamme H, Heymans O. Combined reconstruction of the diabetic foot including revascularization and free-tissue transfer. J Reconstr Microsurg 2004; 20: 511-517
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Vermassen FE, van Landuyt K. Combined vascular reconstruction and free flap transfer in diabetic arterial disease. Diabetes Metab Res Rev 2000; 16 (16) (Suppl. 01) S33-S36
    CrossrefPubMedGoogle Scholar
  • 17 Ducic I, Attinger CE. Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes. Plast Reconstr Surg 2011; 128: 173-180
    CrossrefPubMedGoogle Scholar
  • 18 Shestak KC, Fitz DG, Newton ED, Swartz WM. Expanding the horizons in treatment of severe peripheral vascular disease using microsurgical techniques. Plast Reconstr Surg 1990; 85: 406-411
    PubMedGoogle Scholar
  • 19 Sunar H, Aygit CA, Afsar Y, Halici U, Duran E. Arterial and venous reconstruction for free tissue transfer in diabetic ischemic foot ulcers. Eur J Vasc Endovasc Surg 2004; 27: 210-215
    CrossrefPubMedGoogle Scholar
  • 20 Moran SL, Illig KA, Green RM, Serletti JM. Free-tissue transfer in patients with peripheral vascular disease: a 10-year experience. Plast Reconstr Surg 2002; 109: 999-1006
    CrossrefPubMedGoogle Scholar
  • 21 Musharafieh R, Atiyeh B, Macari G, Haidar R. Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases. J Reconstr Microsurg 2001; 17: 147-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Ciresi KF, Anthony JP, Hoffman WY, Bowersox JC, Reilly LM, Rapp JH. Limb salvage and wound coverage in patients with large ischemic ulcers: a multidisciplinary approach with revascularization and free tissue transfer. J Vasc Surg 1993; 18: 648-653 , discussion 653–655
    PubMedGoogle Scholar
  • 23 Chen SL, Chen TM, Chou TD, Chang SC, Wang HJ. Distally based sural fasciomusculocutaneous flap for chronic calcaneal osteomyelitis in diabetic patients. Ann Plast Surg 2005; 54: 44-48
    CrossrefPubMedGoogle Scholar
  • 24 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115: 142-147
    PubMedGoogle Scholar
  • 25 Moucharafieh RS, Saghieh S, Macari G, Atiyeh B. Diabetic foot salvage with microsurgical free-tissue transfer. Microsurgery 2003; 23: 257-261
    CrossrefPubMedGoogle Scholar
  • 26 Kim ES, Hwang JH, Kim KS, Lee SY. Plantar reconstruction using the medial sural artery perforator free flap. Ann Plast Surg 2009; 62: 679-684
    CrossrefPubMedGoogle Scholar
  • 27 Czerny M, Trubel W, Zimpfer D , et al. Limb-salvage by femoro-distal bypass and free muscle flap transfer. Eur J Vasc Endovasc Surg 2004; 27: 635-639
    CrossrefPubMedGoogle Scholar
  • 28 McCarthy III WJ, Matsumura JS, Fine NA, Dumanian GA, Pearce WH. Combined arterial reconstruction and free tissue transfer for limb salvage. J Vasc Surg 1999; 29: 814-818 , discussion 818–820
    CrossrefPubMedGoogle Scholar
  • 29 Sonmez E, Safak T. Reconstruction of the soft tissue defects of foot and ankle with neural-island flaps: mono-institutional case series. J Reconstr Microsurg 2011; 27: 403-408
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Prantl L, Babilas P, Roll C , et al. The use of 'fasciocutaneous' and 'osteofasciocutaneous' parascapular flaps for lower limb reconstruction: a retrospective study of 20 patients. J Plast Reconstr Aesthet Surg 2009; 62: 973-980
    CrossrefPubMedGoogle Scholar
  • 31 Dabb RW, Davis RM. Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation. Plast Reconstr Surg 1984; 73: 633-640
    PubMedGoogle Scholar
  • 32 Dutch WM, Arnz M, Jolly GP. Digital artery flaps for closure of soft tissue defects of the forefoot. J Foot Ankle Surg 2003; 42: 208-214
    PubMedGoogle Scholar
  • 33 Yildirim S, Akan M, Aköz T. Soft-tissue reconstruction of the foot with distally based neurocutaneous flaps in diabetic patients. Ann Plast Surg 2002; 48: 258-264
    CrossrefPubMedGoogle Scholar
  • 34 Dabb RW, Davis RM. Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation. Plast Reconstr Surg 1984; 73: 633-640
    PubMedGoogle Scholar
  • 35 Smith MV, Klein SE, Clohisy JC, Baca GR, Brophy RH, Wright RW. Lower extremity-specific measures of disability and outcomes in orthopaedic surgery. J Bone Joint Surg Am 2012; 94: 468-477
    CrossrefPubMedGoogle Scholar
  • 36 Cingi C, Eskiizmir G, Cakli H. Comparative analysis of primary and secondary rhinoplasties according to surgeon's perspective, patient satisfaction, and quality of life. Ann Otol Rhinol Laryngol 2012; 121: 322-327
    CrossrefPubMedGoogle Scholar
  • 37 Wright JG. Outcomes research: what to measure. World J Surg 1999; 23: 1224-1226
    CrossrefPubMedGoogle Scholar
  • 38 Luce EA. Outcome studies and practice guidelines in plastic surgery. Plast Reconstr Surg 1999; 104: 1187-1190
    CrossrefPubMedGoogle Scholar
  • 39 Chow A, Mayer EK, Darzi AW, Athanasiou T. Patient-reported outcome measures: the importance of patient satisfaction in surgery. Surgery 2009; 146: 435-443
    CrossrefPubMedGoogle Scholar
  • 40 Alsarraf R. Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg 2000; 24: 192-197
    CrossrefPubMedGoogle Scholar
  • 41 Alsarraf R, Larrabee Jr WF, Anderson S, Murakami CS, Johnson Jr CM. Measuring cosmetic facial plastic surgery outcomes: a pilot study. Arch Facial Plast Surg 2001; 3: 198-201
    CrossrefPubMedGoogle Scholar
  • 42 Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009; 124: 345-353
    CrossrefPubMedGoogle Scholar
  • 43 Klassen AF, Cano SJ, Scott A, Snell L, Pusic AL. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg 2010; 26: 303-309
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Mortimer D, Segal L. Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Med Decis Making 2008; 28: 66-89
    PubMedGoogle Scholar
  • 45 FuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990; 16: 199-208
    CrossrefPubMedGoogle Scholar
  • 46 Binkley JM, Stratford PW, Lott SA, Riddle DL. North American Orthopaedic Rehabilitation Research Network. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther 1999; 79: 371-383
    PubMedGoogle Scholar
  • 47 Boyle GJ. Does item homogeneity indicate internal consistency or item redundancy in psychometric scales?. Pers Individ Dif 1991; 12: 291-294
    CrossrefPubMedGoogle Scholar
  • 48 Gabel CP, Melloh M, Burkett B, Michener LA. CP. Lower limb functional index: development and clinimetric properties. Phys Ther 2012; 92: 98-110
    CrossrefPubMedGoogle Scholar
  • 49 Acquadro C, Berzon R, Dubois D , et al; PRO Harmonization Group. Incorporating the patient's perspective into drug development and communication: an ad hoc task force report of the Patient-Reported Outcomes (PRO) Harmonization Group meeting at the Food and Drug Administration, February 16, 2001. Value Health 2003; 6: 522-531
    CrossrefPubMedGoogle Scholar