Título / Title

VASCULARIZED FIBULAR FLAP IN OBESE PATIENTS

Introdução / Introdution

Although, the crescent knowledge in bone reconstruction with microsurgery, the fibula flap still remains one of the most difficult free flaps and complications, including the loss of viability of the vascularized bone and pseudarthrosis remains a challenge.
With the crescent obesity in world population, the concern about complications, associated with this comorbidity, is raising. Obesity is associated with higher rates of complications in free flaps surgery and the most common is postoperative infection, which can lead to disastrous results, including total free flap loss and amputation

Objetivo / Purpose

Since there is no conclusion in literature about the influence of obesity in the results of free flaps in orthopaedic surgeries that requires segmental bone reconstruction, this study evaluated if obesity can influence results in vascularized fibula flaps

Material e Método / Material and Methods

A cross-sectional study was conducted with consecutive inclusion of all patients undergoing vascularized fibula flap for upper and lower limb reconstruction at our institution, between July 2014 to July 2017.Institutional review board approved the study. Patients were separated in two groups, based on their BMI: non-obese and obese (BMI≥30 kg/m2)

Resultados / Results

23 vascularized fibular flaps,14 patients were male and 9 female. The indications were: trauma in 13, tumor in 7 and congenital pseudarthrosis of the tibia in three . The most common anatomical area of bone lesion was leg in eight cases, followed by forearm in six cases. Obese patients were significantly associated with an increase in early complications (p= 0,046).At final follow-up

Discussão / Discussion

The indications of vascularized fibula flap includes: limb reconstruction after tumor, trauma and congenital deformities. The complications with this vascularized bone flap remains high and it is necessary to recognize risk factors
Obesity is a common risk factor studied for free flaps complications. For our knowledge, there is no description of obesity influencing specifically bone flaps. We observed that obese patients, with BMI > 30 kg/m2, had more complications with statistically significant difference. When performing surgeries in obese patients, these should be aware of the increased risk.
Although a high rate of complications, our overall success rates are similar to those in the literature, with 13% total flap loss.

Conclusão / Conclusion

Obesity is a risk factor for complication in vascularized fibular flap.

Palavras Chave / Keywork

Microsurgery, Free tissue flaps; Risk factor; Fibula