Introduction:
Significant traumatic injuries to the lower limb can cause compound fractures or degloving requiring complex soft tissue reconstruction. Patients with soft tissue injuries large enough to necessitate latissimus dorsi (LD) free flap may have worse outcomes in return to pre-morbid function, pain and/or increased risk of osteomyelitis with metalware infection, resulting in subsequent amputation. This investigation aimed to identify clinical characteristics predictive of delayed amputation in these patients.
Methods:
A single-centre, single-surgeon retrospective chart review was performed of patients who underwent LD free flap reconstruction for post-traumatic lower limb soft tissue defects over a 15-year period (2007-2022). Medical records were reviewed for demographics, details of injury and reconstruction, peri-operative comorbidities, and post-operative outcomes.
Results:
In total, 29 patients were identified, of whom 5 patients were documented to have undergone delayed amputation, between 1 month and 5 years post-reconstruction. Patients who underwent amputation had compound fractures of the foot and/or ankle requiring orthopaedic fixation. Indications for amputation included persistent pain, infection and vascular insufficiency. Factors noted to correlate with higher risk of amputation included crush injury, delay to reconstruction, and early wound infection.
Conclusion:
Lower limb injuries requiring LD free flap remain high risk post-reconstruction, with several clinical characteristics being potentially predictive of subsequent amputation. Further investigation is needed to establish the true functional outcomes of these patients, including those who had apparent successful limb salvage, to guide patient counselling regarding the functional outcomes expected following such injuries even with the best-case reconstructive outcome, and the risks and benefits of reconstruction versus primary amputation.