P86. A 13-year Experience Of Microsurgical Free Tissue Transfer for Chronic Lower Extremity Wound Limb Salvage: Long-term Outcomes From 356 Flaps at a Tertiary Wound Care Center

PURPOSE: Free tissue transfer (FTT) is a reconstructive option for patients with chronic lower extremity (LE) wounds. This study presents long-term outcomes of a large series of LE FTT in a comorbid population. METHODS: A retrospective review of LE FTT from July 2011 to October 2024 was conducted. Flap success was defined as viability for the first 7 days postoperatively, and takeback referred to any return to the OR for flap revision within this period. RESULTS: A total of 356 LE FTT were performed in 346 patients. Median age and body mass index were 57.5 (IQR: 18) years and 28.9 (IQR: 8.1) kg/m2. Median Charlson Comorbidity Index was 4 (IQR: 3), reflecting prevalent rates of diabetes (n=192 patients, 55.5%), peripheral vascular disease (n=185, 53.5%), and chronic kidney disease (n=38, 11.0%). Before reconstruction, 67 cases (18.9%) required endovascular optimization. Median wound size was 80 (IQR: 72) cm2. Most flaps were fasciocutaneous (n=202 flaps, 56.9%) or muscle (n=116, 32.7%), and utilized end-to-side anastomosis (n=310, 87.1%) with two venous anastomoses (n=290, 81.5%). Flap success rate was 96.1%. Takeback occurred in 17 flaps (4.9%), with a salvage rate of 70.6% (n=12). Patients were followed for a median of 15.7 (IQR: 27.6) months. Limb salvage occurred in 302 patients (87.3%) and 285 (85.1%) were ambulatory at final follow-up. Mortality rate was 5.8% (n=20). CONCLUSION: This study represents the largest review of LE FTT for the treatment of chronic wounds and demonstrates that it is an effective tool in a patient population with multiple comorbidities.