Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 20;8(11):e3211.
doi: 10.1097/GOX.0000000000003211. eCollection 2020 Nov.

Development and Validation of Scoring System to Predict Secondary Amputations in Free Flap Reconstruction

Efstathios Karamanos  1 , Hassan Ahmad  1 , Ahmed A Makhani  1 , Ameesh N Dev  1 , Noah Saad  1 , Bao-Quynh Julian  1 , Husain AlQattan  1 , Howard Wang  1 , Douglas Cromack  1
Affiliations

Development and Validation of Scoring System to Predict Secondary Amputations in Free Flap Reconstruction

Efstathios Karamanos et al. Plast Reconstr Surg Glob Open. .

Abstract

Need for amputation is a potential complication when limb salvage is attempted. The present study aimed to develop a risk assessment tool to predict the risk of future amputation when counseling patients about their reconstructive options.

Methods: All patients undergoing a free flap lower extremity soft tissue reconstruction by the senior author from 2005 to 2019 were retrospectively identified. Patient's demographics, comorbidities, and technical aspects of the operation were extracted. Logistic regressions were used to create a predictive scoring system for future amputation.

Results: A total of 277 patients were identified. Of these patients, two-thirds (183) were used to derive the scoring system and one-third (94) were used to validate the score. In total, 25 of 183 patients (14%) underwent an amputation. A stepwise forward logistic regression identified age > 55 years, smoking, acute wound, aggressive fluid resuscitation intra-operatively, inability to use a superficial vein for drainage, and inability to use the posterior tibialis artery for anastomosis as independent predictors of need for future amputations. The beta co-efficients were used to create the scoring system, and the patients were categorized into mild, moderate, and severe risk based on their cumulative score. The validity of the scoring system was verified by using the one-third validation cohort.

Conclusions: In patients undergoing free flap reconstruction of the lower extremity, the need for future amputation is 14%. The use of a scoring system can guide the surgeon's and patient's decision regarding limb salvage.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Probability of amputation based on the scoring system.
Fig. 2.
Fig. 2.
Probability of amputation based on risk categories.
See this image and copyright information in PMC

References

    1. Schirò GR, Sessa S, Piccioli A, et al. Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system. BMC Musculoskelet Disord. 2015;16:372. - PMC - PubMed
    1. Shanmuganathan R. The utility of scores in the decision to salvage or amputation in severely injured limbs. Indian J Orthop. 2008;42:368–376. - PMC - PubMed
    1. Wettstein R, Schürch R, Banic A, et al. Review of 197 consecutive free flap reconstructions in the lower extremity. J Plast Reconstr Aesthet Surg. 2008;61:772–776. - PubMed
    1. Loja MN, Sammann A, DuBose J, et al. ; AAST PROOVIT Study Group. The mangled extremity score and amputation: time for a revision. J Trauma Acute Care Surg. 2017;82:518–523. - PMC - PubMed
    1. Chien TL, Hsiao FY, Chen LJ, et al. Development and validation of a risk scoring system for cephamycin-associated hemorrhagic events. Sci Rep. 2019;9:12905. - PMC - PubMed