D142. The Role of Local Flap Reconstruction for Limb Salvage in Patients With Moderate to Severe Medial Arterial Calcification

PURPOSE: The medial arterial calcification (MAC) scoring system predicts adverse limb events. This study applies MAC scoring to patients undergoing local flap reconstruction. METHODS: Patients that underwent foot and ankle local flaps from January 2010 to November 2022 were reviewed. Radiographs were used to assigned MAC scores: absent (MAC=0-1), moderate (MAC=2-3), or severe (MAC≥4). RESULTS: 182 patients underwent local flap reconstruction: 104 (57.1%) absent MAC, 32 (17.6%) moderate MAC, and 46 (25.3%) severe MAC. Patients with severe MAC demonstrated significantly higher rates of diabetes mellitus (p=0.001), end-stage renal disease (p<0.001), and peripheral neuropathy (p<0.001), and more often required a vascular intervention before reconstruction (p=0.001). Flap-related outcomes and rates of major limb amputation were statistically similar between MAC groups. By a median of 16.5 (IQR: 36.6) months, limb salvage was 84.1% and not independently associated with MAC on multivariable analysis. Postoperative vascular intervention (absent: 10.7% vs. severe: 28.1% vs. severe: 17.4%; p=0.054), podiatric reoperation (absent: 35.6% vs. severe: 40.6% vs. severe: 56.5%; p=0.056), and mortality (absent: 19.4% vs. severe: 34.4% vs. 32.6%; p=0.102) were not independently associated with MAC on multivariable analysis. CONCLUSION: Local flaps are a viable option in patients with MAC. If utilizing a vasculo-plastic approach, severe MAC should not prevent limb salvage efforts via local flap reconstruction.