150. Assessment of Resiliency and Psychological Distress in Patients With Below the Knee Amputations Compared to Lower Extremity Free Tissue Transfer: Results From a Tertiary Limb Salvage Center

PURPOSE: Patients with lower extremity (LE) wounds that require treatment with major surgery—whether salvage with microsurgical LE free tissue transfer (FTT) or limb loss via below the knee amputation (BKA)—may experience varying degrees psychological distress. While a BKA may allow for quicker return to ambulation, FTT is a technically challenging surgery that often confers prolonged hospital recovery and rehabilitation. At the most extreme end of psychological distress includes suicidal ideation. This study compares levels of resilience and psychological distress in comorbid patients with chronic LE wounds who underwent either BKA or limb salvage with FTT. METHODS: Using a cross-sectional study design, we reviewed patients who underwent FTT or BKA and answered postoperative surveys from June 2022 to May 2024. Surveys were collected at 1 month, 3-month, 12-month, 2-year, and 5-year intervals. Patient reported outcome measures included PROM Information System Pain Intensity (PROMIS-3a), Connor-Davidson Resilience Scale (CD-RISC), Lower Extremity Functional Scale (LEFS), psychological distress and suicidal ideation via Self-Reporting Questionnaire 20-item (SRQ-20). Demographics, comorbidities, and surgical histories were compared between groups. RESULTS: A total of 213 surveys were completed by 82 patients in a multidisciplinary limb tertiary care limb salvage center. Of these patients, 50 underwent BKA (61%) and 32 underwent FTT (39%). Patient characteristics are summarized. Age and sex were similar between BKA and FTT patients (p=0.62, p=0.32). BKA patients had a higher Charlson Comorbidity Index compared to FTT patients (4.56, IQR: 2.5 vs. 3.97, IQR: 2.1; p=0.27). BKA patients reported overall less median pain than FTT patients (PROMIS-T score; 43.1, IQR: 18.5 vs. 51.4, IQR: 28.6 p=0.004). Median SRQ-20 scores were <10 at across all time periods for both BKA and FTT patients, indicating no psychological distress. BKA and FTT patients had comparable overall function (LEFS household ambulator stage <35, p=0.62). Both BKA and FTT patients demonstrated similar 1-month (8, IQR 0 vs. 8, IQR 0, p=1), 3-month (8, IQR: 2 vs. 8, IQR: 2, p=0.81), 12-month (8, IQR: 2 vs. 8, IQR: 1, p=0.158), 2 year (8, IQR: 2 vs. 6, IQR:2, p= 0.582) and 5-year (6.7 ± 1.4 vs. 6.6 ± 1.3, p=0.72) resilience (CD-RISC). Across all time points, suicidal ideation was observed in 4 BKA patients (8 %) compared to 0 FTT patients (p=0.13). CONCLUSION: Use of a multidisciplinary limb salvage team which focuses on careful preoperative functional analysis and long-term postoperative care, including psychological treatment, can achieve favorable psychological distress scores. Patients who undergo either FTT or BKA show comparably high resilience and no psychological distress up to 5 years postoperatively. Given drastic changes in function and the progression toward patient-centered care, resiliency and psychological distress should continue to be assessed in patients who undergo lower extremity amputation and limb-salvage procedures.