title: Correlating patient-reported outcomes and ambulation success following microsurgical lower extremity reconstruction in comorbid patients.
abstract: BACKGROUND
  Microsurgical lower extremity flap reconstruction provides a valuable option for soft tissue reconstruction in comorbid patients. Limb salvage with flap reconstruction can result in limb length preservation. Despite this, few studies have examined the impact of salvage on patient-centered metrics in this cohort of patients. Therefore, we investigated quality of life and patient satisfaction following microsurgical lower extremity reconstruction in this high-risk patient population. Factors that resulted in improved patient-centered outcomes were also identified.
  
  
  METHODS
  A retrospective review was conducted of all patients who had lower extremity free flap reconstruction (FFR) following lower extremity wounds. High-risk patients were identified as having multiple comorbidities and chronic wounds. Patients with traumatic wounds were excluded from analysis. Quality of life was evaluated with the Short Form-12 (SF-12) validated survey. Phone interviews were conducted for survey evaluations.
  
  
  RESULTS
  From 2005 to 2010, 57 patients had lower extremity flap reconstruction that met the inclusion criteria. Average follow-up was 236.6 weeks (range, 111-461). Comorbidities included diabetes (36%), PVD (24.6%), and ESRD (7%). Limb length preservation and ambulation occurred in 82.5% (47/57). Revisional surgery occurred in 33.3% (19/57). Survey response rate was 63%. Average SF-12 PCS and MCS scores were 44.9 and 59.8 for patients able to achieve ambulation and 27.6 and 61.2 for nonambulatory patients.
  
  
  CONCLUSIONS
  Microsurgical flap reconstruction is a valuable reconstructive option in high-risk patients. Quality of life is comparable with a normalized population if limb salvage is successful. Quality of life is decreased significantly when failure to ambulate occurs in this patient cohort.
authors.affiliation: Department of Plastic Surgery, Georgetown University, Washington, DC.
authors.forename: Ketan M
authors.initials: KM
authors.lastname: Patel
authors.forename: James M
authors.initials: JM
authors.lastname: Economides
authors.forename: Brenton
authors.initials: B
authors.lastname: Franklin
authors.forename: Michael
authors.initials: M
authors.lastname: Sosin
authors.forename: Christopher
authors.initials: C
authors.lastname: Attinger
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000150:complications; D059026:Diagnostic Self Evaluation; D058752:Free Tissue Flaps; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D058729:Peripheral Arterial Disease / Q000150:complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012074:Remission Induction; D012189:Retrospective Studies; D016138:Walking; D055815:Young Adult