D34. Refining and Expanding Free Tissue Transfer for the Comorbid, Chronic Wound Population: Analyzing Multiplex Surgical Care in 300 Lower Extremity Free Flaps

PURPOSE: Free tissue transfer (FTT) for lower extremity (LE) salvage in the chronic wound, co-morbid population requires a multidisciplinary team invested in delivering multiplex surgical care. It is critical to analyze overall outcomes in this complex and high healthcare expenditure population. METHODS: A retrospective review of 300 LE FTTs by a single surgeon was performed, comparing the first 200 (7/2011-2/2020) to the last 100 (2/2020-1/2023) patients. Demographics, comorbidities, preoperative management, intraoperative details, and outcomes were collected. intraoperative details, and outcomes data were collected. RESULTS: In the group of last 100 FTTs, patients had a higher prevalence of diabetes (67.0% vs. 48.5%, p=0.002) and peripheral vascular disease (56.0% vs. 24.5%, p<0.000). Preoperative imaging showed higher rates of venous reflux (81.9% vs. 67.8%; p=0.034) and venous thrombosis (25.5% vs. 10.5%; p=0.003). They also received more preoperative endovascular interventions (23.0% vs. 16.5%, p=0.039). Intraoperatively, this group had a greater proportion of calcified vessels (43.0% vs. 20.5%; p<0.001). Rates of partial flap necrosis were higher for this group (7% vs. 3%; p=0.012). However, no other significant differences were found in rates of early reoperation, hematoma, or infection. The most recent 100 FTT had greater flap success (98% vs 95.5% vs; p=0.347) and shorter median time to ambulation (2.23 vs. 4.37 months; p<0.001). CONCLUSION: The multidisciplinary care model is critical for success in this complex patient population. With increasing surgical experience, case volume and repetition, the multiplex care team can offer higher FTT success rates and enhanced outcomes to an overall sicker population.