Nutritional markers for predicting lower extremity free tissue transfer outcomes in the chronic wound population.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
revised:
04
02
2021
received:
14
10
2020
accepted:
09
07
2021
pubmed:
7
8
2021
medline:
12
1
2023
entrez:
6
8
2021
Statut:
ppublish
Résumé
Optimizing nutritional status is critical to maximize flap success and healing. Prealbumin and albumin have been utilized as easily obtained proxies for overall nutritional status. The aim of this study was to investigate whether these markers are correlated with healing time and overall flap healing after lower extremity (LE) free tissue transfer (FTT) in the chronic wound population. A retrospective review of LE chronic wound FTT patients treated by a single surgeon at our institution from 2011 to 2020 was performed. Data collected included demographics, comorbidities, flap characteristics, and perioperative labs. The outcomes of interest were flap healing (FH) and time to flap healing (TFH). We identified 69 patients undergoing LE FTT for limb salvage meeting our inclusion criteria. When using a threshold of <3.5 g/dl for low albumin and < 20 mg/dl for low prealbumin, no significance was found between FH or TFH and preoperative albumin or preoperative prealbumin. With low albumin defined as <2.7 g/dl with the prealbumin threshold unchanged, TFH was significantly increased, and FH was significantly decreased compared with the defined normal preoperative albumin group. Low preoperative albumin, when defined as <3.5 g/dl, and prealbumin did not correlate with TFH or FH. Contrarily, when defined as <2.7 g/dl, low preoperative albumin correlated significantly with increased TFH and decreased FH rates. Further investigation into validated biomarkers and their thresholds is needed to assess the effect of nutritional status on wound healing and guide perioperative optimization.
Sections du résumé
BACKGROUND
BACKGROUND
Optimizing nutritional status is critical to maximize flap success and healing. Prealbumin and albumin have been utilized as easily obtained proxies for overall nutritional status. The aim of this study was to investigate whether these markers are correlated with healing time and overall flap healing after lower extremity (LE) free tissue transfer (FTT) in the chronic wound population.
METHODS
METHODS
A retrospective review of LE chronic wound FTT patients treated by a single surgeon at our institution from 2011 to 2020 was performed. Data collected included demographics, comorbidities, flap characteristics, and perioperative labs. The outcomes of interest were flap healing (FH) and time to flap healing (TFH).
RESULTS
RESULTS
We identified 69 patients undergoing LE FTT for limb salvage meeting our inclusion criteria. When using a threshold of <3.5 g/dl for low albumin and < 20 mg/dl for low prealbumin, no significance was found between FH or TFH and preoperative albumin or preoperative prealbumin. With low albumin defined as <2.7 g/dl with the prealbumin threshold unchanged, TFH was significantly increased, and FH was significantly decreased compared with the defined normal preoperative albumin group.
CONCLUSIONS
CONCLUSIONS
Low preoperative albumin, when defined as <3.5 g/dl, and prealbumin did not correlate with TFH or FH. Contrarily, when defined as <2.7 g/dl, low preoperative albumin correlated significantly with increased TFH and decreased FH rates. Further investigation into validated biomarkers and their thresholds is needed to assess the effect of nutritional status on wound healing and guide perioperative optimization.
Substances chimiques
Prealbumin
0
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51-56Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Austin, S. R., Wong, Y. N., Uzzo, R. G., Beck, J. R., & Egleston, B. L. (2015). Why summary comorbidity measures such as the Charlson comorbidity index and Elixhauser score work. Medical Care, 53(9), e65-e72. https://doi.org/10.1097/MLR.0b013e318297429c
Beck, F. K., & Rosenthal, T. C. (2002). Prealbumin: A marker for nutritional evaluation. American Family Physician, 65(8), 1575-1578. www.aafp.org/afpAMERICANFAMILYPHYSICIAN1575
Black, C. K., Zolper, E. G., Ormiston, L. D., Schwitzer, J. A., Luvisa, K., Attinger, C. E., Fan, K. L., & Evans, K. K. (2020). Free anterolateral thigh versus Vastus Lateralis muscle flaps for coverage of lower extremity defects in chronic wounds. Annals of Plastic Surgery, 85(S1), S54-S59. https://doi.org/10.1097/SAP.0000000000002335
Clemente, G., Gallo, M., & Giorgini, M. (2018). Modalities for assessing the nutritional status in patients with diabetes and cancer. Diabetes Research and Clinical Practice, 142, 162-172. https://doi.org/10.1016/j.diabres.2018.05.039
Dellière, S., & Cynober, L. (2017). Is transthyretin a good marker of nutritional status? Clinical Nutrition, 36(2), 364-370. https://doi.org/10.1016/j.clnu.2016.06.004
Demling, R. H. (2009). Nutrition, anabolism, and the wound healing process: An overview. Eplasty, 9, e9. http://www.ncbi.nlm.nih.gov/pubmed/19274069
Dempsey, D. T., Mullen, J. L., & Buzby, G. P. (1988). The link between nutritional status and clinical outcome: Can nutritional intervention modify it? The American Journal of Clinical Nutrition, 47(2 SUPPL), 352-356. https://doi.org/10.1093/ajcn/47.2.352
Falola, R. A., Lakhiani, C., Green, J., Patil, S., Jackson, B., Bratescu, R., Anghel, E., Steinberg, J., Kim, P., Attinger, C., & Evans, K. (2018). Assessment of function after free tissue transfer to the lower extremity for chronic wounds using the lower extremity functional scale. Journal of Reconstructive Microsurgery, 34(5), 327-333. https://doi.org/10.1055/s-0037-1621736
Gillis, C., & Wischmeyer, P. E. (2019). Pre-operative nutrition and the elective surgical patient: Why, how and what? Anaesthesia, 74, 27-35. https://doi.org/10.1111/anae.14506
Hülshoff, A., Schricker, T., Elgendy, H., Hatzakorzian, R., & Lattermann, R. (2013). Albumin synthesis in surgical patients. Nutrition, 29(5), 703-707. https://doi.org/10.1016/j.nut.2012.10.014
Järbrink, K., Ni, G., Sönnergren, H., Schmidtchen, A., Pang, C., Bajpai, R., & Car, J. (2016). Prevalence and incidence of chronic wounds and related complications: A protocol for a systematic review. Systematic Reviews, 5, 152. https://doi.org/10.1186/s13643-016-0329-y
Karir, A., Stein, M. J., Shiga, S., & Zhang, J. (2020). Reconstruction of lower extremity defects using the Serratus anterior free flap: A systematic review and retrospective case series. Journal of Reconstructive Microsurgery, 36(2), 116-126. https://doi.org/10.1055/s-0039-1697920
Keller, U. (2019). Nutritional laboratory markers in malnutrition. Journal of Clinical Medicine, 8(6), 775. https://doi.org/10.3390/jcm8060775
Kolbenschlag, J., Hellmich, S., Germann, G., & Megerle, K. (2013). Free tissue transfer in patients with severe peripheral arterial disease: Functional outcome in reconstruction of chronic lower extremity defects. Journal of Reconstructive Microsurgery, 29(9), 607-614. https://doi.org/10.1055/s-0033-1354739
Lee, J. L., Oh, E. S., Lee, R. W., & Finucane, T. E. (2015). Serum albumin and Prealbumin in calorically restricted, nondiseased individuals: A systematic review. The American Journal of Medicine, 128(9), 1023.e1-1023.e22. https://doi.org/10.1016/j.amjmed.2015.03.032
Lu, J., DeFazio, M., Lakhiani, C., Abboud, M., Penzler, M., Elmarsafi, T., Kim, P., Attinger, C., & Evans, K. (2019). Limb salvage and functional outcomes following free tissue transfer for the treatment of recalcitrant diabetic foot ulcers. Journal of Reconstructive Microsurgery, 35(2), 117-123. https://doi.org/10.1055/s-0038-1667363
Makhija, S., & Baker, J. (2008). The subjective global assessment: A review of its use in clinical practice. Nutrition in Clinical Practice, 23(4), 405-409. https://doi.org/10.1177/0884533608321214
Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, D. (2018). An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value in Health, 21(1), 27-32. https://doi.org/10.1016/j.jval.2017.07.007
Oh, T. S., Lee, H. S., & Hong, J. P. (2013). Diabetic foot reconstruction using free flaps increases 5-year-survival rate. Journal of Plastic, Reconstructive & Aesthetic Surgery, 66(2), 243-250. https://doi.org/10.1016/j.bjps.2012.09.024
Olsson, M., Järbrink, K., Divakar, U., Bajpai, R., Upton, Z., Schmidtchen, A., & Car, J. (2019). The humanistic and economic burden of chronic wounds: A systematic review. Wound Repair and Regeneration, 27(1), 114-125. https://doi.org/10.1111/wrr.12683
Quain, A. M., & Khardori, N. M. (2015). Nutrition in wound care management: A comprehensive overview. Wounds a Compend Clin Res Pract., 27(12), 327-335. https://pubmed.ncbi.nlm.nih.gov/27447105/
Rocha, N. P., & Fortes, R. C. (2015). Total lymphocyte count and serum albumin as predictors of nutritional risk in surgical patients. Arquivos Brasileiros de Cirurgia Digestiva, 28(3), 193-196. https://doi.org/10.1590/S0102-67202015000300012
Torgersen, Z., & Balters, M. (2015). Perioperative nutrition. The Surgical Clinics of North America, 95(2), 255-267. https://doi.org/10.1016/j.suc.2014.10.003
Williford, W. O. (1991). Perioperative Total parenteral nutrition in surgical patients. The New England Journal of Medicine, 325(8), 525-532. https://doi.org/10.1056/NEJM199108223250801