D126. Do GLP-1 Medications Influence Lower Extremity Free Tissue Transfer Outcomes in Diabetic Limb Salvage Patients? A 13-year Retrospective Review

PURPOSE: Glucagon-Like Peptide 1 (GLP-1) medications are increasingly used for obesity and diabetes management. This study investigates the impact of GLP-1 medications on lower extremity (LE) free tissue transfer (FTT) outcomes in diabetic limb salvage patients. METHODS: A retrospective review of all LE FTT performed in diabetic patients from 2011 to 2024 was performed. RESULTS: 198 LE FTT were performed in 192 diabetic patients: GLP-1 medication was used by 21 patients (10.9%) at the time of FTT, with a median usage duration of 14.1 months (IQR: 27.7 months). GLP-1 usage significantly increased over the study period (p=0.005). The GLP-1 group had higher median body mass indices (31.2, IQR: 7.4 vs. 29.3, IQR: 8.3; p=0.024). Rates of peripheral arterial disease (68.8%), neuropathy (67.2%), and chronic kidney disease (18.2%) were similar between groups. Median A1c was similar between the GLP-1 group and controls (7.1, IQR: 2.4 vs. 7.4, IQR: 3.4; p=0.333). Incidence of immediate flap success (100.0% vs. 96.6%, p=1.000), flap revision within the first 7 postoperative days (13.0% vs. 5.1%, p=0.150), and partial flap necrosis (13.0% vs. 5.6%, p=0.121) was similar between GLP-1 and control groups. By a median follow-up of 16.8 (IQR: 27.2) months, rate of major lower extremity amputation trended to be lower in the GLP-1 group (4.4% vs. 21.1%, p=0.086). CONCLUSION: These preliminary data suggest that GLP-1 medication may have a positive benefit on long-term limb salvage outcomes among diabetic patients with chronic LE wounds. With the continued rise in GLP-1 usage, further prospective investigation is warranted.