Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults

Raquel Bernardelli Iamaguchi; Lucas Sousa Macedo; Alvaro Baik Cho; Marcelo Rosa de Rezende; Rames Mattar; Teng Hsiang Wei

doi:10.1055/s-0041-1735946

Microsurgical Reconstruction in an Orthopedic Hospital: Indications and Outcomes in Adults

Rev Bras Ortop (Sao Paulo). 2022 Mar 11;57(5):772-780. doi: 10.1055/s-0041-1735946. eCollection 2022 Oct.

Authors

Raquel Bernardelli Iamaguchi¹, Lucas Sousa Macedo¹, Alvaro Baik Cho¹, Marcelo Rosa de Rezende¹, Rames Mattar¹, Teng Hsiang Wei¹

Affiliation

¹ Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

Abstract

Objective Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications. Methods Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis. Results We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours ( p = 0.032) and obesity ( p = 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count ( p = 0.001). Conclusion The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.

Keywords: free tissue flaps; microsurgery; orthopedic procedures; tissue transplantation; trauma.

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