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J Reconstr Microsurg 2021; 37(07): 622-630
DOI: 10.1055/s-0041-1724126
Original Article

Evaluation of the American Society of Anesthesiologists Physical Status Classification System in Risk Assessment for Lower Extremity Reconstruction with Free Tissue Transfer

Andrés A. Maldonado    *
1   Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Academic Hospital of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
2   Department of Plastic Surgery, University Hospital Getafe, Madrid, Spain
,
Rabanus Steinebach‡   *
1   Department for Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Academic Hospital of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
,
M. Carmen Morillo
3   Department of Topographic Engineering and Cartography, Universidad Politécnica de Madrid, Spain
,
Michael Sauerbier
4   Private Practice for Hand and Plastic Surgery, Bad Homburg v. d. Höhe, Germany
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Abstract

Background The applicability of free flap reconstruction for lower extremity (LE) defects in high-risk patients continues to require ongoing review. The aim of this study was to analyze the risk factors, management, and outcome of LE free flap reconstruction in high-risk (American Society of Anesthesiologists [ASA] class 3 or 4) patients.

Methods A retrospective chart review was performed for all patients who underwent LE reconstruction in our Institution (Level I Trauma Center) from 2013 to 2019. Medical records and the authors' prospectively maintained database were analyzed with respect to ASA class, comorbidities, and postoperative complications. All patients were treated using the same pre-, intra-, and postoperative multidisciplinary approach.

Results A total of 199 patients were analyzed. Sixty-six flaps were transferred in 60 patients with an ASA class 3 or higher. High-risk patients did not present a higher rate of flap loss or LE amputation. The overall flap success rate was 92%. There were five flap losses in high-risk patients. Three of these five patients underwent a successful second free flap reconstruction. The overall success rate of LE reconstruction in high-risk patients was 90%. Four patients with successful free flap ended up in LE amputation due to bone infection and two patients underwent an amputation after the first free flap failure.

Conclusion Free flap reconstruction for LE defects in high-risk patients is a safe and reliable procedure for selected patients when an experienced multidisciplinary team is involved. Bone infection was the only variable associated with LE amputation.

Keywords

lower extremity - microsurgery - free flap - high-risk patients - ASA classification

* These authors contributed equally to this study.




Publication History

Received: 15 June 2020

Accepted: 13 January 2021

Article published online:
25 February 2021

© 2021. Thieme. All rights reserved.

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