The Impact of Increased Body Mass Index on Patient Outcomes and Complications in Microsurgical Lower Extremity Reconstruction

IF 1.5 3区医学 Q3 SURGERY Microsurgery Pub Date : 2024-09-05 DOI:10.1002/micr.31231

Eloise W. Stanton, Artur Manasyan, Elizabeth Boudiab, Joseph N. Carey, David A. Daar

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Abstract

Background

Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction.

Methods

A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories.

Results

A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10–15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years.

Conclusions

BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.

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体质指数增加对显微外科下肢重建术患者疗效和并发症的影响。

背景：体重指数（BMI）升高是伤口延迟愈合和感染等并发症的已知围手术期风险因素。然而，人们对体重指数升高如何影响创伤后下肢（LE）微血管重建后的预后还缺乏了解：方法：2007 年至 2022 年期间，一家一级创伤中心对接受创伤后下肢微血管重建术的患者进行了回顾性研究。记录了人口统计学、皮瓣/伤口细节、并发症和结果。患者按疾病控制中心的体重指数分层：结果：共纳入 398 名患者，平均 BMI 为 28.2 ± 5.8。近一半（45%）的LE缺损位于腿的远端三分之一处，27.5%位于中间三分之一处，34.4%位于近端三分之一处。与筋膜皮瓣（16.8%）相比，大多数重建手术使用含肌肉的皮瓣（74.4%）。手术方法包括游离皮瓣（47.6%）和局部皮瓣（52.5%）。III级肥胖患者不行动的可能性明显高于非肥胖患者（OR：4.10，95% CI 1.10-15.2，P = 0.035）。在最后的随访中，30.1% 的 III 级肥胖患者可以行走，但需要轮椅（42.3%）或辅助设备（26.9%）。并发症发生率与肥胖程度无明显差异（0.704）。整个组群的平均随访时间为 5.8 年：结论：在 LE 重建中，BMI 对患者护理和手术决策至关重要。结论：BMI 对 LE 重建中的患者护理和手术决策至关重要，有必要开展进一步研究，以优化 BMI 较高患者的治疗效果，从而减轻术后并发症的负担，促进患者的整体康复。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.