Orr Shauly, Samuel Teles, Gregory Stone, Daniel J Gould and Ketan M Patel*
Department of Plastic and Reconstructive Surgery, University of Southern California, USAFulltext PDF
Background: Previously published literature has provided a large number of clinical data from hundreds of medical centers across the country among patients that have undergone limb salvage and lower extremity amputation. These studies commonly suffer from retrospective and prospective design flaws, low statistical power, non uniform inclusion criteria and inconsistent endpoints that are hard to assess.
Methods: A literature search was conducted, including terms related to outcomes in free flap reconstruction or amputation of the lower extremity. Inclusion criteria for this systematic review centered around the number or proportion of patients experiencing a specific outcome.
Results: The only outcomes unique to both cohorts were hospital length of stay and time- tooperate. In this meta-analysis, operative time was significantly longer in free flap reconstruction cases (p=0.041) than in those patients undergoing amputation.
Interestingly, the mean number of hospital days was reported to be only 23.36 days in free flap limb salvage patients and significantly higher in amputation patients (32.19 days, p=0.046).
Conclusion: Free flap reconstruction of the lower extremity was associated with lower postoperative risks associated with length of stay results of this comprehensive review of the literature demonstrate a diversity in reporting practices. Transitioning to a universally accepted reporting standard will strengthen the literature and help future clinicians in situations that require surgical
intervention with no clear medical indication between either limb salvage or amputation.
Lower extremity trauma; Microsurgical reconstruction; Amputation; Limb salvage
Shauly O, Teles S, Stone G, Gould DJ, Patel KM. Lower Extremity Limb Salvage and Amputation: A Systematic Review and Meta-Analysis of Reported Outcomes and the Role of Microsurgery. Ann Plast Reconstr Surg. 2020;4(2):1056..