Microsurgery
Predictors of Salvage After Re-Exploration of Compromised Free Anterolateral Thigh Flaps for Post-Traumatic Extremity Reconstruction
By Hinzmann J, Kalkan S, Schmidt SV and 6 others.
Abstract
Introduction
Vascular compromise after free anterolateral thigh (ALT) flap reconstruction is a time-critical event and may result in total flap loss despite re-exploration. Although earlier re-exploration is associated with improved salvage, this relationship is often simplified by arbitrary thresholds, and internally validated prediction models remain scarce. We aimed to quantify this relationship and assess the additional predictive value of systemic factors beyond timing.
Methods
This retrospective single-center cohort study included all free ALT flaps for post-traumatic extremity reconstruction between 2005 and 2020 that underwent re-exploration for suspected vascular compromise on postoperative day (POD) 0-4. The primary endpoint was flap salvage at POD 5. Intraoperative findings were compared between salvaged and failed flaps. Univariable logistic regression examined the association between POD and salvage, followed by a multivariable model with prespecified covariates. Restricted cubic splines assessed nonlinearity, and 1000 bootstrap resamples were used to obtain optimism-corrected estimates of discrimination and calibration.