title: Free flap lower extremity reconstruction in the obese population: does weight matter?
abstract: The obesity epidemic continues to grow, and we have observed greater numbers of obese individuals among patients seeking lower extremity reconstruction at our institution. These patients may present a greater reconstructive challenge, thus we sought to identify risk factors and differences in outcomes among patients undergoing lower extremity reconstruction.In this study we have performed a retrospective cohort analysis of patients undergoing lower extremity reconstruction with free tissue transfer at our institution from 2005 to 2012. Patients were classified using the World Health Organization criteria for obesity. Records were reviewed for patient characteristics, mechanism of injury, indications for reconstruction, and surgical technique, with a focus on intraoperative and early postoperative complications and outcomes.A total of 43 out of the 119 patients undergoing lower extremity reconstruction were obese (body mass index ≥ 30). Mechanism of injury, wound location, and the indications for reconstruction were similar in both cohorts. No significant differences were found in operative characteristics and techniques, including the type of flap utilized, operative time, or thrombotic events. No significant differences were seen in complication rates overall, however, obese patients more frequently needed second flaps (11.6 vs. 0%, p=0.005).This study concludes that successful lower extremity reconstruction can be performed in the obese population, with few differences in complication rates and outcomes relative to healthy weight patients.
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Cleveland
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.affiliation: Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*