IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?

Objective: Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery. Methods: A cohort study was conducted in all patients undergoing free flap limb reconstructions between July 2014 and July 2018. Patients were separated in two groups based on their body mass index (BMI): non-obese and obese (BMI≥30 kg/m2). Results: Twenty-three free vascularized fibular flaps were studied. The indications included trauma in 13, tumors in 7, and congenital pseudarthrosis of the tibia in 3. Obese patients were associated with an increase in surgical complications (p=0.038). During the final follow-up, consolidation was obtained in 17 patients (74%). Conclusion: Obesity is a risk factor for complications in free vascularized fibular flap surgery. Level of evidence IV, original article.