D117. Skin Graft Failure at the Time of Muscle Free Tissue Transfer in the Comorbid Population Undergoing Limb Salvage Procedures

PURPOSE: The use of muscle free flaps (FF) with the supplementary use of a split-thickness skin graft (STSG) is often required to complete coverage for complex chronic lower extremity (LE) wounds. This study aims to characterize the use of STSG after LE muscle FF and compare the outcome between immediate versus delayed timing of STSG. METHODS: A retrospective review of 92 patients receiving a STSG after LE muscle FF was performed. Demographics, comorbidities, FF and STSG operative details, and complications were collected. Primary outcomes included full healing, greater than 85% take, and graft failure anytime postoperatively. RESULTS: After FF procedure, 71.4% (n=65) received immediate STSG placement and 28.6% (n=26) received a delayed STSG. Median time for delayed STSG was 12 (IQR = 9) days, of which 73.1% (n=19) patients received wound bed prep in the interim. 31.8% (n=20) immediate STSG achieved full healing compared to 16.0% (n=4) patients in delayed STSG (p=0.186). Overall graft failure rate was 31.5%, occurring at a median time of 35 (IQR = 54) days. History of Charcot arthropathy independently predicted higher rates of graft failure on multivariate logistic regression (OR = 7.06, p=0.021). Rates of graft failure were not significant for immediate (27.0%) and delayed (42.3%) STSG (p=0.157). CONCLUSION: While there are certain LE comorbidities that significantly contribute to higher graft failures, our results do not show significant differences in outcomes for immediate versus delayed staging of LE muscle FF and STSG procedures.