title: Systematic review of patient-centered outcomes following lower extremity flap reconstruction in comorbid patients.
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.
  
  
  CONCLUSIONS
  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.
authors: School of Medicine, Georgetown University Hospital, Washington, DC, USA.
authors: James M
authors: JM
authors: Economides
authors: Ketan M
authors: KM
authors: Patel
authors: Karen Kim
authors: KK
authors: Evans
authors: Elizabeth
authors: E
authors: Marshall
authors: Christopher E
authors: CE
authors: Attinger
mesh_terms: D015897:Comorbidity; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D016138:Walking; D016474:Weight-Bearing