Comparative Analysis of Complication Profiles and Readmission Rates in Truncal and Extremity Flaps for Reconstructive Surgery

Common flaps in reconstructive surgery include truncal flaps (deep inferior epigastric perforator, latissimus dorsi, transverse rectus abdominis myocutaneous) and extremity flaps (anterolateral thigh, radial forearm flap). This study compares complication profiles and readmission rates between these donor-site groups. The Nationwide Readmission Database (2017–2020) was queried to identify adults undergoing truncal or extremity flap procedures. After a 1:1 match for age, gender, payer type and comorbidities, postoperative complication rates were compared using a logistic multivariable regression model. Ninety-day readmission rates and indications were compared using multivariate logistic regression. In the matched cohort (n = 10,358), extremity flaps had higher odds of flap thrombosis (OR = 1.83, p = 0.001), sepsis (OR = 1.13, p = 0.024), nonprocedure-specific infections (OR = 1.51, p < 0.001), and hemorrhage (OR = 1.68, p = 0.024). Truncal flaps had higher odds of seroma (OR = 1.63, p < 0.001), postoperative infections (OR = 1.63, p < 0.001), and postoperative pain (OR = 1.50, p < 0.001). Extremity flaps had a higher overall readmission rate than truncal flaps (21.40 vs. 5.41%) and were more often readmitted for nonprocedure-specific infection (OR = 3.15, p < 0.001). Truncal flaps were more often readmitted for postoperative infection (OR = 1.43, p < 0.001), partial necrosis (OR = 8.85, p = 0.014), and postoperative pain (OR = 1.90, p < 0.001). Truncal and extremity flaps exhibit distinct complication profiles. Higher extremity flap readmission rates were driven by nonprocedural-site infections, highlighting the potential need for tailored postoperative care based on flap type.