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Microvascular Free Tissue Transfer for Upper Extremity Limb Salvage in the Obese Population
Joseph Amadeo Lewcun, MD, Brooks Kelly, MD, Stephanie Shin, MD, Megan R Newsom, MD, Annabel Baek, MD, Brooks J Knighton, MD, Tae Chong, MD; Paschalia Mountziaris, MD, PhD
Virginia Commonwealth University, Richmond, VA
Introduction: Obese patients undergoing microvascular free tissue transfer (FTT) for breast reconstruction have increased rates of flap loss and higher complication rates. Despite this there isn't an association with obesity and higher complication rates in patients undergoing FTT for lower extremity salvage. The aim of this study is to determine the impact of obesity on complication risk in patients undergoing FTT for upper limb salvage.
Methods: We conducted a retrospective review of all patients who underwent microvascular free tissue transfer for upper limb salvage at a single academic medical center from 2013 to 2024. Outcome measures included rates of surgical site infection, wound healing complications, venous/arterial thrombus, partial/complete flap loss, length of hospital stay and readmission rates. We then compared complication rates in obese patients (defined as BMI ?30 kg/m
2) and those without obesity.
Results: Thirty-six patients (55.6% male, mean age 40.6 years) underwent free tissue transfer for upper limb salvage. 50.0% (n=18) of patients had a BMI ?30 kg/m
2 and 50.0% (n=18) had a BMI <30 kg/m
2. 33.3% (n=6) and 66.6% (n=12) of patients in the obesity group were reconstructed with muscle-only flaps and fasciocutaneous flaps respectively, while 100.0% (n=18) of patients in the non-obesity group were reconstructed with fasciocutaneous flaps (p=0.007). The rates of complete flap loss were 5.6% (n=1) in the obesity group and 11.1% (n=2) in the non-obesity group (p=0.546). There were no significant differences in rates of partial flap loss, surgical site infection, wound healing complications, venous/arterial thrombus, length of hospital stay, or rates of readmission between the obesity and non-obesity groups.
Conclusions: Obese patients undergoing FTT for upper limb salvage experience similar rates of complications to those without obesity, which is consistent with previous study findings in the lower extremity population. Surgeons may favor muscle-only flaps in patients with obesity, as fasciocutaneous flaps in this population may include considerable unwanted bulk.
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