Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults

Iamaguchi, Raquel Bernardelli; Macedo, Lucas Sousa; Cho, Alvaro Baik; Rezende, Marcelo Rosa de; Mattar Júnior, Rames; Wei, Teng Hsiang

doi:10.1055/s-0041-1735946

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. bras. ortop. 57 (05) • Sep-Oct 2022 • https://doi.org/10.1055/s-0041-1735946 copy

Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications.

Methods

Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis.

Results

We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours (p= 0.032) and obesity (p= 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count (p= 0.001).

Conclusion

The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.

Keywords
free tissue flaps; trauma; microsurgery; orthopedic procedures; tissue transplantation

Gender	Number of flaps (%)
Male	130 (76%)
Female	41 (24%)
Indications
Trauma	109 (63.7%)
Brachial plexus lesion	42 (24.6%)
Tumor	10 (5.8%)
Burn scar	6 (3.5%)
Others	4 (2.4%)
Comorbidities (isolated or associated)
Obesity	34 (19.9%)
Mean obesity BMI = 33.0 kg / m²
Mean general group BMI = 26.13 kg / m²
Smokers	16 (9.3%)
Systemic hypertension	11 (6.4%)
Diabetes mellitus	9 (5.3%)
Other	5 (3.0%)
171 free flaps in 166 patients

Type of flap	Number of flaps (%)
ALT	47 (45.6%)
Latissimus dorsi	25 (24.3%)
Vascularized fibular flap	14 (13.6%)
Lateral arm	8 (7.8%)
Parascapular	2 (1.9%)
Others	7(6.8%)
Type of arterial anastomosis
End-to-side	73 (70.9%)
End-to-end	30 (29.1%)
Number of venous anastomoses
1 vein	58 (56.3%)
2 veins	45 (43.7%)
Time of free flap from trauma
< 21 days	50 (48.5%)
> 21 days	53 (51.5%)
103 free flaps in traumatic cases

Type of flap	Number of flaps (%)
ALT	53 (31%)
Free gracilis	45 (26.3%)
Vascularized fibular flap	21 (12.3%)
Latissimus dorsi	26 (15.2%)
Lateral arm	10 (5.8%)
Others	16 (9.4%)
Type of arterial anastomosis
End-to-side	88 (51.5%)
End-to-end	83 (48.5%)
Number of venous anastomosis
1 vein	101 (59.1%)
2 veins	70 (40.9%)
171 free flaps in 166 patients

	Univariate	Multivariate
	p-value	OR	95%CI	p-value
Ischemia time > 2 hours	0.007	2.2	1.1–4.6	0.032
Vein graft	0.014	3.8	1.1–16.7	0.08
ETS artery	0.112	1.8	0.9–3.8	0.12
BMI ≥ 30 kg/m²	0.004	2.5	1.1–5.7	0.007

	Univariate	Multivariate
	p-value	OR	95%CI	p-value
Ischemia time > 2 hours	0.004	2.3	1.0–6.4	0.07
Resident performing anastomosis	0.093	3.5	0.8–16.6	0.11
One venous anastomosis	0.323	1.4	0.6–3.3	0.44
Vein graft	0.005	4.2	10.9–18.7	0.06
BMI ≥ 30 kg/m²	0.031	2.7	1.0–6.9	0.04

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Raquel Bernardelli Iamaguchi, M.D., MSc., PhD., Rua Dr. Ovídio Pires de Campos, 333, 05403-010, São Paulo-SP, Brazil (e-mail: rbiamaguchi@gmail.com).