Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale

Reuben A. Falola; Chrisovalantis Lakhiani; Jocelyn Green; Siya Patil; Brandon Jackson; Rachel Bratescu; Ersilia Anghel; John S. Steinberg; Paul J. Kim; Christopher E. Attinger; Karen K. Evans

doi:10.1055/s-0037-1621736

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2018; 34(05): 327-333
DOI: 10.1055/s-0037-1621736

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale

Reuben A. Falola

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Chrisovalantis Lakhiani

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Jocelyn Green

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Siya Patil

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Brandon Jackson

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Rachel Bratescu

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Ersilia Anghel

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

John S. Steinberg

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Paul J. Kim

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Christopher E. Attinger

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

,

Karen K. Evans

¹Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia

› Author Affiliations

Abstract

Background Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1–5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey.

Methods A retrospective chart review was conducted at a single academic medical center of 101 consecutive free flaps, from 2011 to 2016. Of the flaps that met inclusion criteria, 39 had completed LEFS surveys. Mean LEFS scores were calculated, and the effects of risk factors such as diabetes, age, and smoking status were analyzed.

Results The mean LEFS score after free tissue transfer was 50.3 (SD ± 21.1), with a mean follow up survey time of 3.0 years (SD ± 1.3). The score correlated with Stage 4 function, or "independent community ambulation,” and age was the only demographic factor associated with decreased functionality in this group. This is compared with mean LEFS score of 43.1 (SD ± 18.4) in cohort of 55 below knee amputations (BKAs), and 38.3 (SD ± 14.9) in 28 above knee amputations (AKAs), both correlating with Stage 3 function: “limited community ambulation.”

Conclusions Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.

Keywords

microvascular surgery - lower extremity functional scale - chronic wound

Full Text

References

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