Health-related quality of life after below knee amputation stump salvage using free latissimus dorsi flap is comparable to that of local flap coverage ! $.
Health-related quality of life after below knee amputation stump salvage using free latissimus dorsi flap is comparable to that of local flap coverage ! $
Jussi&Repo1,&Risto&P.&Roine1,2,&Erkki&Tukiainen1&$ $
1University$of$Helsinki$and$Helsinki$University$Hospital,$HUS,$Finland$$ 2University$of$Eastern$Finland,$Kuopio,$Finland$
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Background$
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Insufficient$ local$ so;$ .ssues$ for$ amputa.on$ stump$ coverage$ may$ require$ microvascular$ reconstruc.on$ for$ stump$ preserva.on.$The$authors$have$previously$demonstrated$that$the$healthVrelated$quality$of$life$(HRQoL)$a;er$below$knee$ amputa.on$stump$salvage$using$a$free$la.ssimus$dorsi$flap$is$impaired$compared$to$that$of$age$and$gender$standardized$ Finnish$general$popula.on.1$The$aim$of$the$present$study$was$to$compare$the$HRQoL$a;er$microvascular$la.ssimus$dorsi$ flap$stump$salvage$to$that$a;er$local$muscle$flap$among$pa.ents$who$underwent$below$knee$amputa.on$a;er$trauma
Pa2ents'and'Methods' 'The$authors$approached$pa.ents$who$had$undergone$below$knee$stump$salvage$with$free$la.ssimus$dorsi$flap$or$stump$
coverage$using$a$local$muscle$flap,$and$rehabilitated$to$below$knee$prosthesis$users$a;er$trauma.$Primary$outcomes$were$ the$comparability$of$scores$in$the$Finnish$version$of$the$prosthesis$evalua.on$ques.onnaire$(PEQ)2$and$the$generic$15D3$ HRQoL$instrument$between$these$two$pa.ent$groups.$The$authors$set$sta.s.cal$significance$at$p$=$0.05.$
Results' Nine$free$la.ssimus$dorsi$flap$and$15$local$flap$coverage$pa.ents$(mean$ages$41$and$50$years,$respec.vely)$completed$the$ ques.onnaires.$ Mean$ .me$ from$ reconstruc.on$ and$ amputa.on$ to$ crossVsec.onal$ assessment$ was$ 13$ and$ nine$ years,$ respec.vely.$No$sta.s.cal$significant$difference$between$the$two$groups$in$the$total$score$of$prosthesisVrelated$quality$of$ life$(67$vs$72$points)$or$15D$index$(0.889$vs$0.859),$or$between$their$subscales$was$found$(Figures$1$and$2).$Pa.ents$who$ had$undergone$free$la.ssimus$dorsi$flap$salvage$were$notably$worse$off$in$the$PEQ$scales$of$Appereance,$Frustra.on$and$ Sounds$(Figure$2).$ Figure 2. Scores of the PEQ scales between the two groups. Red line illustrates latissimus dorsi reconstruction and green line local flap closure.
Figure 1. Scores of the 15D dimensions between the two groups. Red line illustrates latissimus dorsi flap reconstruction and green line local flap closure.
100 0,95
90
0,75
0,65
80 Level value
Level value
0,85
T-test *** p < 0.001 Mann-Whitney U * p < 0.05 *** p < 0.001
0,55
70
T-test *** p < 0.001 Mann-Whitney U * p < 0.05 *** p < 0.001
60 50 40
Dimensions
Scales
Conclusions' Higher$ amputa.on$ due$ to$ insufficient$ amount$ of$ local$ so;$ .ssues$ a;er$ trauma$ or$ sequelae$ such$ as$ infec.on$ can$ be$ avoided$ using$ the$ free$ la.ssimus$ dorsi$ flap$ for$ belowVknee$ amputa.on$ stump$ preserva.on.$ Evidence$ from$ this$ study$ suggests$ that$ HRQoL$ a;er$ below$ knee$ amputa.on$stump$salvage$using$the$free$la.ssimus$dorsi$ flap$ is$ comparable$ to$ that$ of$ local$ flap$ coverage$ a;er$ trauma$amputa.on$or$sequelae$(Figure$3).$$
References' 1. Repo$JP,$Roine$RP,$Sintonen$H,$Tukiainen$H.$Value$ Health$2016;19(7):A480$ 2. Repo$JP,$Piitulainen$K,$Häkkinen$A,$Roine$RP,$ Kau.ainen$H,$Becker$P,$Tukiainen$EJ.$Reliability$and$ validity$of$the$Finnish$version$of$the$Prosthesis$ Evalua.on$Ques.onnaire.$Disabil$Rehabil.$doi:$ 10.1080/09638288.2017.1323032.$$ 3. Sintonen$H..$Ann$Med$2001;33:328V336.$
Figure$ 3.$ On$ the$ le;$ a$ local$ flap$ closure$ (A$ and$ B).$ On$ the$ right$ la.ssimus$ dorsi$ flap$ reconstruc.on$ for$ sequeale$ (C)$ or$ trauma$defect$(D).$ A$
B$
C$
D$
