Abstract
The incidence of chronic lower extremity (LE) wounds continues to increase. Lower limb amputations are associated with increased cardiovascular exertion, further decline in functional ability, and higher mortality rates. As such, there has been a shift towards limb salvage modalities. These include local debridement with advanced wound care, revascularization, bony reconstruction, and soft tissue reconstruction. Perioperative planning for soft tissue reconstruction requires careful consideration of several factors, including patient comorbidities, wound size and location, exposed underlying structures, and in the case of possible free flap, patency of donor and recipient vessels. This article reviews the perioperative factors that should be considered in preparation for successful soft tissue reconstruction of the LE.
Highlights
Chronic wounds of the lower extremity (LE) can be defined as wounds that fail to heal within three months of onset
LE wounds are a relatively common condition, affecting 1% of the adult population and 3.6% of people older than age 65[1,2,3]. This incidence continues to rise as a result of an aging population and increased atherosclerotic risk factors such as smoking, obesity, and diabetes mellitus (DM)[1]
The ideal perioperative HgbA1c is less than 7; if a patient’s HgbA1c is greater than 7, this is not a contraindication to free tissue transfer (FTT) because it may be falsely elevated perioperatively secondary to hyperglycemia from acute infection
Summary
Chronic wounds of the lower extremity (LE) can be defined as wounds that fail to heal within three months of onset. LE wounds are a relatively common condition, affecting 1% of the adult population and 3.6% of people older than age 65[1,2,3] This incidence continues to rise as a result of an aging population and increased atherosclerotic risk factors such as smoking, obesity, and diabetes mellitus (DM)[1]. Following major LE amputation, 5-year mortality rates can reach 56.6%, which are higher than breast, colon, or prostate cancer[8]. This is likely due to increased cardiovascular exertion, further decline in functional ability, and exacerbation of existing comorbidities[9]. Major LE amputation increases the risk of contralateral amputation by up to 50% within two years[10,11,12]
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