Abstract
Background Defects at the forefoot frequently require microsurgical reconstruction; however,
reconstructive failure can lead to results inferior to primary amputation. The purpose
of this study was to identify independent factors affecting surgical outcomes and
hospitalization time in these patients.
Methods All patients that underwent free flap reconstruction of the forefoot between 2008
and 2019 were reviewed retrospectively. Statistical evaluation included binary logistic
regression and correlation analysis.
Results A total of 93 free flap procedures were performed in 87 patients. The most common
defect etiologies were acute trauma (30 cases; 32.3%), diabetic foot syndrome (20
cases; 21.5%), and infection (17 cases; 18.3%). Muscle flaps were used in 50 cases
(53.8%) and fasciocutaneous flaps were used in 43 cases (46.2%). Major complications
occurred in 24 cases (25.8%) including 11 total flap losses and 2 partial flap losses.
Minor complications occurred in 38 cases (40.9%). Patients aged 60 years or above
were at significant higher risk of major complications (p = 0.029). Use of fasciocutaneous flaps (odds ratio [OR]: 14.341; p = 0.005), arterial hypertension (OR: 18.801; p = 0.014), and operative time (min) (OR: 1.010; p = 0.029) were identified as individual risk factors for major complications. Two
venous anastomoses significantly reduced the risk of major complications (OR: 0.078;
p = 0.022). Multiresistant bacterial wound colonization (OR: 65.152; p < 0.001) and defect size (OR: 1.007; p = 0.045) were identified as independent risk factors for minor complications. The
median hospital stay was 28 days (7–85 days). Age significantly correlated with the
length of hospital stay (r = 0.405, p < 0.01).
Conclusion Our study identified independent risk factors that might help to make individual
decisions whether to target microsurgical forefoot reconstruction or primary amputation.
Two venous anastomoses should be performed whenever feasible, and muscle free flaps
should be preferred in patients at higher risk of major surgical complications.
Keywords
microsurgical forefoot reconstruction - free flap - risk factors - comorbidities -
complications
