RSS-Feed abonnieren
DOI: 10.1055/s-0037-1621736
Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale
Publikationsverlauf
09. August 2017
18. November 2017
Publikationsdatum:
16. Februar 2018 (online)
![](https://www.thieme-connect.de/media/jrm/201805/lookinside/thumbnails/10-1055-s-0037-1621736_170196-1.jpg)
Abstract
Background Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1–5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey.
Methods A retrospective chart review was conducted at a single academic medical center of 101 consecutive free flaps, from 2011 to 2016. Of the flaps that met inclusion criteria, 39 had completed LEFS surveys. Mean LEFS scores were calculated, and the effects of risk factors such as diabetes, age, and smoking status were analyzed.
Results The mean LEFS score after free tissue transfer was 50.3 (SD ± 21.1), with a mean follow up survey time of 3.0 years (SD ± 1.3). The score correlated with Stage 4 function, or "independent community ambulation,” and age was the only demographic factor associated with decreased functionality in this group. This is compared with mean LEFS score of 43.1 (SD ± 18.4) in cohort of 55 below knee amputations (BKAs), and 38.3 (SD ± 14.9) in 28 above knee amputations (AKAs), both correlating with Stage 3 function: “limited community ambulation.”
Conclusions Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.
-
References
- 1 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 (04) 371-383
- 2 Economides JM, Patel KM, Evans KK, Marshall E, Attinger CE. Systematic review of patient-centered outcomes following lower extremity flap reconstruction in comorbid patients. J Reconstr Microsurg 2013; 29 (05) 307-316
- 3 DeFazio MV, Han KD, Akbari CM, Evans KK. Free tissue transfer after targeted endovascular reperfusion for complex lower extremity reconstruction: setting the stage for success in the presence of mutlivessel disease. Ann Vasc Surg 2015; 29 (06) 1316.e7-1316.e15
- 4 Ducic I, Rao SS, Attinger CE. Outcomes of microvascular reconstruction of single-vessel lower extremities: limb salvage versus amputation. J Reconstr Microsurg 2009; 25 (08) 475-478
- 5 Mathes SJ, Feng LJ, Hunt TK. Coverage of the infected wound. Ann Surg 1983; 198 (04) 420-429
- 6 Gupta SK, Veith FJ, Ascer E, Flores SAW, Gliedman ML. Cost factors in limb-threatening ischaemia due to infrainguinal arteriosclerosis. Eur J Vasc Surg 1988; 2 (03) 151-154
- 7 Mackey WC, McCullough JL, Conlon TP. , et al. The costs of surgery for limb-threatening ischemia. Surgery 1986; 99 (01) 26-35
- 8 Kucan JO, Robson MC. Diabetic foot infections: fate of the contralateral foot. Plast Reconstr Surg 1986; 77 (03) 439-441
- 9 Toursarkissian B, Shireman PK, Harrison A, D'Ayala M, Schoolfield J, Sykes MT. Major lower-extremity amputation: contemporary experience in a single Veterans Affairs institution. Am Surg 2002; 68 (07) 606-610
- 10 Schofield CJ, Libby G, Brennan GM, MacAlpine RR, Morris AD, Leese GP. ; DARTS/MEMO Collaboration. Mortality and hospitalization in patients after amputation: a comparison between patients with and without diabetes. Diabetes Care 2006; 29 (10) 2252-2256
- 11 Thorud JC, Plemmons B, Buckley CJ, Shibuya N, Jupiter DC. Mortality after nontraumatic major amputation among patients with diabetes and peripheral vascular disease: A systematic review. J Foot Ankle Surg 2016; 55 (03) 591-599 . doi: 10.1053/j.jfas.2016.01.012
- 12 Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care 1990; 13 (05) 513-521
- 13 Ollendorf DA, Kotsanos JG, Wishner WJ. , et al. Potential economic benefits of lower-extremity amputation prevention strategies in diabetes. Diabetes Care 1998; 21 (08) 1240-1245
- 14 Mayfield JA, Reiber GE, Maynard C, Czerniecki JM, Caps MT, Sangeorzan BJ. Survival following lower-limb amputation in a veteran population. J Rehabil Res Dev 2001; 38 (03) 341-345
- 15 Serafin D, Sabatier RE, Morris RL, Georgiade NG. Reconstruction of the lower extremity with vascularized composite tissue: improved tissue survival and specific indications. Plast Reconstr Surg 1980; 66 (02) 230-241
- 16 Hollenbeck ST, Woo S, Komatsu I, Erdmann D, Zenn MR, Levin LS. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125 (03) 924-934 . Doi 10.1097/PRS.0b013e3181cc9630
- 17 Kadam D. Limb salvage surgery. Indian J Plast Surg 2013; 46 (02) 265-274 . doi 10.4103/0970-0358.118603
- 18 Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means?. Plast Reconstr Surg 1999; 103 (04) 1212-1220
- 19 Acute Treatment Patterns for Lower Extremity Trauma in the United States. Flaps versus Amputation. Mundy LR, Truong T, Shammas RL, Gage MJ, Pomann GM, Hollenbeck ST. J Reconstr Microsurg 2017; 33 (08) 563-570
- 20 Doukas WC, Hayda RA, Frisch HM. , et al. The military extremity trauma amputation/limb salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am 2013; 95 (02) 138-145 . doi 10.2106/JBJS.K.00734