Not all flaps are created equal: Assessing the impact of active smoking in muscle-only versus perforator flaps for patients undergoing nonelective extremity-free tissue transfer-A case control study.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
26
04
2021
received:
25
03
2021
accepted:
05
08
2021
pubmed:
15
8
2021
medline:
8
9
2021
entrez:
14
8
2021
Statut:
ppublish
Résumé
Active smoking is known to impair wound healing following free tissue transfer for reconstruction due to its vasoconstrictive effect on the microcirculation. The aim of this study was to evaluate the impact of flap selection on flap loss, in nonelective, traumatic extremity-free soft tissue transfer in active smokers. All patients undergoing a free tissue transfer for acute trauma of the extremity at a level I trauma center from 2011 to 2017 were identified. Breast reconstruction and osseous/osseocutaneous flaps were excluded. The study population was divided in two groups based on the type of flap used (muscle versus perforator flap). Factors known to be associated with impaired wound healing were extracted from the database. Primary outcome was major smoking related complications (complete/partial flap loss). Secondary outcomes included minor flap-related complications (infection, dehiscence) and donor site complications. The impact of smoking was assessed for the different type of flaps using multivariate analyses. A total of 118 flaps were identified during the study period. Out of those, 52 were perforator-based fasciocutaneous flaps, while 66 were muscle flaps. Active smoking status resulted in a statistically significant increase in the incidence of major and minor complications in the perforator flap group (36% vs. 4%, adjusted odds ratio, AOR [95%CI]: 2.31[1.48,19.30], adj-p = 0.021 and 32% vs. 17%, AOR [95% CI]: 1.23[1.11,14.31], adj-p = 0.034) but had no impact in the muscle group. The present study suggests a higher incidence of flap related complications in smokers when a perforator flap was selected but no impact when a muscle flap was utilized.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
513-521Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Booi, D. I., Debats, I. B., Boeckx, W. D., & van der Hulst, R. R. (2007). Risk factors and blood flow in the free transverse rectus abdominis (TRAM) flap. Annals of Plastic Surgery, 59(4), 364-371. https://doi.org/10.1097/sap.0b013e318030b083
Centers for Disease Control and Prevention. 2019. Current cigarette smoking among adults in the United States. www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm.
Chang, D. W., Reece, G. P., Wang, B., Robb, G. L., Miller, M. J., Evans, G. R. D., Langstein, H. N., & Kroll, S. S. (2000). Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction. Plastic & Reconstructive Surgery, 105(7), 2374-2380. https://doi.org/10.1097/00006534-200006000-00010
Ciresi, K. F., & Mathes, S. J. (1993). The classification of flaps. The Orthopedic Clinics of North America, 24, 383-391.
Colen, D. L., Colen, L. B., Levin, L. S., & Kovach, S. J. (2018). Godina's principles in the twenty-first century and the evolution of lower extremity trauma reconstruction. Journal of Reconstructive Microsurgery, 34(8), 563-571. https://doi.org/10.1055/s-0037-1607348 Epub 2017 Nov 9.
Crippen, M. M., Patel, N., Filimonov, A., Brady, J. S., Merchant, A. M., Baredes, S., & Park, R. C. W. (2019). Association of smoking tobacco with complications in head and neck microvascular reconstructive surgery. JAMA Facial Plastic Surgery, 21(1), 20-26. https://doi.org/10.1001/jamafacial.2018.1176
Ehrl, D., Heidekrueger, P., Haas, E., Coenen, M., Giunta, R., Ninkovic, M., & Broer, P. (2018). Does cigarette smoking harm microsurgical free flap reconstruction? Journal of Reconstructive Microsurgery, 34(07), 492-498. https://doi.org/10.1055/s-0038-1639377
Ehrl, D., Heidekrueger, P., Ninkovic, P. M., & Broer, P. (2017). Effect of preoperative medical status on microsurgical free flap reconstructions: A matched cohort analysis of 969 cases. Journal of Reconstructive Microsurgery., 34(03), 170-175. https://doi.org/10.1055/s-0037-1607309
Garip, M., Van Dessel, J., Grosjean, L., Politis, C., & Bila, M. (2021). The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: A systematic review and meta-analysis. The British Journal of Oral & Maxillofacial Surgery, 59(3), e79-e98. https://doi.org/10.1016/j.bjoms.2020.07.020
Goltsman, D., Munabi, N. C. O., & Ascherman, J. A. (2017). The association between smoking and plastic surgery outcomes in 40,465 patients. Plastic and Reconstructive Surgery, 139(2), 503-511. https://doi.org/10.1097/prs.0000000000002958
Grønkjaer, M., Eliasen, M., Skov-Ettrup, L. S., Tolstrup, J. S., Christiansen, A. H., Mikkelsen, S. S., & Becker, U. (2014). Preoperative smoking status and postoperative complications. Annals of Surgery, 52, 71.
Herold, C., Gohritz, A., Meyer-Marcotty, M., Steiert, A., Jokuszies, A., Vaske, B., & Vogt, P. (2010). Is there an association between comorbidities and the outcome of microvascular free tissue transfer? Journal of Reconstructive Microsurgery, 27(02), 127-132. https://doi.org/10.1055/s-0030-1268851
Karanas, Y. L., Nigriny, J., & Chang, J. (2008). The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery, 28(8), 632-634. https://doi.org/10.1002/micr.20551
Mathes, S. J., & Alpert, B. S. (1980). Advances in muscle and musculocutaneous flaps. Clinics in Plastic Surgery, 7, 15-26.
Mosely, L. H., & Finseth, F. (1977). Cigarette smoking; impairment of digital blood flow and wound healing in the hand. The Hand, 9, 97-101.
Nolan, J., Jenkins, R. A., Kurihara, K., & Schultz, R. C. (1985). The acute effects of cigarette smoke exposure on experimental skin flaps. Plastic and Reconstructive Surgery, 75, 544-549.
Rees, T. D. (1985). The acute effects of cigarette smoke exposure on experimental skin flaps: A discussion. Plastic and Reconstructive Surgery, 75, 550-551.
Sherwin, M. A., & Gastwirth, C. M. (1990). Detrimental effects of cigarette smoking on lower extremity wound healing. The Journal of Foot Surgery, 29, 84-87.
Silverstein, P. (1992). Smoking and wound healing. The American Journal of Medicine, 93(1A), 22S-24S. https://doi.org/10.1016/0002-9343(92)90623-J
Wong, A. K., Joanna Nguyen, T., Peric, M., Shahabi, A., Vidar, E. N., Hwang, B. H., Niknam Leilabadi, S., Chan, L. S., & Urata, M. M. (2015). Analysis of risk factors associated with microvascular free flap failure using a multi-institutional database. Microsurgery, 35(1), 6-12.