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Page 4 of 9 Kovar et al. Plast Aesthet Res 2019;6:10 I http://dx.doi.org/10.20517/2347-9264.2019.09

Table 1. Patient and wound characteristics compared between patients with vascular pedicle skin grafting and primary closure
Variable Skin graft to pedicle (n = 13) Pedicle closed (n = 63) Odds ratio P value
Demographics
AGE Mean (Range) 47 (47-69) 59 (20-77) - > 0.05
Male 8 (61%) 48 (76%) 0.41 0.21
Comorbidity
BMI 28 (21-40) 27 (19-44) - > 0.05
Diabetes 7 (54%) 18 (28%) 2.3 0.21
Malnourished albumin > 3 7 (54%) 10 (16%) 5.1 0.02
Renal disease CKD 6 (46%) 4 (6.3%) 9.5 0.0065
Tobacco 2 (15%) 25 (39.6%) 0.16 0.09
Peripheral arterial disease 4 (31%) 13 (20.6%) 1.6 0.54
Coronary artery disease 1 (7.7%) 7 (11.1%) 0.86 0.89
Preop antiplatelet agent (ASA/Plavix) 5 (38%) 43 (68.3%) 0.41 0.21
Preop vascular imaging (CTA/Angio) 6 (46%) 33 (52.3%) 1.27 0.72
Recipient wound
Pre-flap vascular intervention 2 (15%) 7 (11.1%) 1.9 0.45
Peripheral bypass 0 (0%) 2 (3.1%) - -
Endo vascular revascularization 2 (15%) 6 (9.5%) 2.3 0.36
Procedure done Aplasty, bypass Aplasty, bypass
< 3 Vessel runoff 7 (54%) 16 (25.4%) 6.56 0.01
Upper extremity 1 (7%) 7 (11.1%) - -
Lower extremity 12 (93%) 54 (85%) 1.56 0.69
Previous amputation 4 (31%) 8 (12.7%) 4.42 0.04
Wound etiology
Arterial 6 (46%) 27 (42.8%) 1.89 0.36
Traumatic 5 (38%) 35 (55.5%) 0.49 0.31
Malignant 2 (15%) 8 (12.7%) 1.65 0.56
Chronic wound 4 (31%) 25 (39.6%) 0.96 0.95
Infected 5 (38%) 37 (58.7%) 0.64 0.52
Hardware 2 (15%) 21 (33.3%) 0.47 0.37
Osteomyelitis proven 3 (23%) 17 (26.9%) 1.1 0.89
Revascularization 2 (15%) 6 (9.5%) 2.29 0.35
The table compares patients with pedicle skin-grafting versus primary closure over the pedicle. Patient demographic features,
comorbidities, wound etiology and location are described by rate and frequency. Univariate analysis was performed and reported as odds
ratios where appropriate. P < 0.05 are highlighted and reached statistical significance

regression model to identify independent risk factors associated with flap loss. Statistical significance was
defined as a P < 0.05. All analyses were performed using Prism, version 5.0b (GraphPad Software, La Jolla,
CA).

RESULTS
The review identified 75 patients who underwent a total of 76 fasciocutaneous free flaps with either a
primary closure over the vascular pedicle (n = 63) or a skin graft (n = 13) closure [Table 1].

Patient comorbidities included diabetes (n = 25), chronic kidney disease (n = 10), tobacco use (n = 27),
peripheral vascular disease (n = 17), and coronary artery disease (n = 8). Additional clinical characteristics,
such as antiplatelet use, were assessed as contributing factors to wound etiology. The two cohorts were
comparable in age, gender, BMI, and co-morbidities, excluding renal disease which was present in 46%
(n = 6) of skin grafted group compared to 6.3% (n = 4) in the primary closure group. The pathogenesis of
all patient wounds included history of trauma (n = 40), malignancy (n = 10), chronic wounds (n = 29),
infected wounds (n = 42), and hardware exposure requiring tissue coverage (n = 23).

Skin grafting closure was performed for 13 flaps, while the remaining 63 flaps utilized primary closure. The
difference in flap area was not significantly different between the skin graft and primary closure groups,