IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?

Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery.

Methods:

A cohort study was conducted in all patients undergoing free flap limb reconstructions between July 2014 and July 2018. Patients were separated in two groups based on their body mass index (BMI): non-obese and obese (BMI≥30 kg/m²).

Results:

Twenty-three free vascularized fibular flaps were studied. The indications included trauma in 13, tumors in 7, and congenital pseudarthrosis of the tibia in 3. Obese patients were associated with an increase in surgical complications (p=0.038). During the final follow-up, consolidation was obtained in 17 patients (74%).

Conclusion:

Obesity is a risk factor for complications in free vascularized fibular flap surgery. Level of evidence IV, original article.

Keywords:
Microsurgery; Free tissue flaps; Tissue transplantation; Risk factors; Fibula

Patient	Age	Sex	Indication	Comorbidities	Defect location	Size defect (mm)	BMI (kg/m²)	Complications	Type of fixation	Consolidation (Y/N)	Deambulation (Y/N)/ Amputation
#1	9	F	Tumor		Shoulder	221	19,37		Plate and screws	Y	N/A
#2	17	F	Tumor		Leg	103	18,83		Plate and screws	Y	Y
#3	51	M	Tumor		Leg and Ankle	232	26,93		External fixator and screws	N	Y - cane
#4	31	M	Trauma	Smoking; Diabetes	Leg	68	19,38		External fixator and K-wires	Y	Y
#5	42	M	Trauma	Smoking	Leg	140	25,71		External fixator and K-wires	Y	Y - crutches
#6	45	M	Tumor		Arm	56	30,46	Anastomoses revision; total flap loss	Plate and screws	N	N/A
#7	23	M	Trauma		Thigh	232	20,62	Anastomoses Revision	External fixator and K-wires	N	Amputation
#8	23	M	Trauma	Smoking	Forearm	93	24,22	Anastomoses Revision; Skin island flap loss	K-wires	Y	N/A
#9	2	F	CPT		Leg	48	15,00		External fixator and K-wires	Y	Y
#10	36	M	Trauma	Smoking	Clavicle	73	25,22	Dehiscence; Local flap for coverage	Plate and screws	Y	N/A
#11	10	F	Tumor		Shoulder	158	15,48	Anastomoses Revision; Skin island flap loss	Plate and screws	Y	N/A
#12	45	F	Trauma	Smoking; Hypertension; Hypothyroidism	Wrist	69	40,40	Anastomoses Revision	K-wires	Y	N/A
#13	24	F	Trauma		Leg	123	21,60	Partial Flap Loss; Local flap for coverage	External fixator and K-wires	Y	Y
#14	57	F	Tumor	Diabetes; Hypertension	Wrist	90	27,92		Plate and screws	Y	N/A
#15	26	M	Tumor	Cocaine use	Forearm	124	20,16		Plate and screws	Y	N/A
#16	3	M	CPT		Leg	80	19,38	Anastomoses revision; Total Flap Loss	External fixator and K-wires	N	Amputation
#17	28	M	Trauma		Forearm	86	30,31	Post-operative infection; Skin island flap loss	K-wires	Y	N/A
#18	29	F	Tumor		Forearm	111	23,78		Plate and screws	Y	N/A
#19	26	F	Trauma		Forearm	142	33,80	Post-operative infection	Plate and screws	Y	N/A
#20	10	M	CPT		Leg	82	15,03		External fixator and screws	N	Amputation
#21	40	M	Trauma		Foot	57	27,16	Anastomoses revision; Total flap loss	Plate and screws	N	Amputation
#22	38	M	Trauma		Ankle	79	22,94		External fixator, screws and K-wires	Y	Y
#23	31	M	Trauma		Forearm	43	30,02	Anastomoses Revision; Hematoma drainage	Plate and screws	Y	N/A

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[1] Correspondence: Raquel Bernardelli Iamaguchi. Rua Dr. Ovídio Pires de Campos, 333, São Paulo, SP, Brazil. 05403-010. rbiamaguchi@gmail.com