title: Optimization of Free-Flap Limb Salvage and Maximizing Function and Quality of Life Following Oncologic Resection: 12-Year Experience.
abstract: BACKGROUND
  A knowledge gap exists regarding factors to optimize limb salvage and function following oncologic resection.
  
  
  METHODS
  We conducted a retrospective review of all free flaps performed for upper extremity (UE) and lower extremity (LE) salvage from 2000 to 2012.
  
  
  RESULTS
  Overall, 220 patients underwent free-flap reconstruction for limb salvage (UE: 64, and LE: 156). Flaps were classified as muscle-only (n = 77), myocutaneous (MC; n = 67), or fasciocutaneous (FC; n = 76). Smoking, diabetes, peripheral vascular disease, and prior chemotherapy or radiation had no impact on complications, while osteomyelitis significantly increased the risk of infection (odds ratio [OR] 19.5, confidence interval [95% CI] 3.77-100.64; p = 0.0004), wound healing complications (OR 7.51, 95% CI 2.21-25.49; p = 0.001), and amputation (OR 4.63, 95% CI 1.41-15.19; p = 0.01). Hardware increased the risk for flap loss (OR 4.92, 95% CI 1.33-18.23; p = 0.017). MC and FC flaps had increased risks for hematoma (p = 0.02) and reoperation for microvascular complications (p = 0.005) but were at lower risk for infection (OR 0.14, 95% CI 0.02-0.87; p = 0.03) compared with muscle-only flaps. There were a total of seven total flap losses (3.2%), with significantly increased risks for MC/FC flaps (OR 2.58, 95% CI 1.06-6.26; p = 0.03). For LE, 103 patients (66.3%) were fully ambulatory, while 23 (14.7%) were ambulatory with assistance (mean Musculoskeletal Tumor Society score (MSTS) 80.2, and Karnofsky score 84.0). For UE, 49 patients (76.6%) were able to perform their activities of daily living independently (mean MSTS 80.2, and Karnofsky score 86.0). Overall, 190 patients (86.4%) were successfully salvaged.
  
  
  CONCLUSIONS
  Free flaps can be performed reliably for limb salvage following tumor extirpation. While MC/FC flaps demonstrated improved postoperative function, they were at significantly higher risk for take-backs and total flap loss.
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA. eichang@mdanderson.org.
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Hughes
authors.affiliation: Department of Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Moeller
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Roman J
authors.initials: RJ
authors.lastname: Skoracki
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.affiliation: Department of Orthopedic Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Valerae O
authors.initials: VO
authors.lastname: Lewis
authors.affiliation: Department of Plastic Reconstructive Surgery, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
mesh_terms: D000203:Activities of Daily Living; D000671:Amputation, Surgical; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000592:standards*; D006801:Humans; D023821:Limb Salvage / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000592:standards*; D012189:Retrospective Studies