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Page 6 of 9 Kondra et al. Plast Aesthet Res 2022;9:36 https://dx.doi.org/10.20517/2347-9264.2021.121

Table 3. Postoperative outcomes & complications
n (%)
Flap complications
Any postoperative complication 18 (26.1%)
Any infection 12 (17.6%)
Osteomyelitis 11 (15.9%)
Flap revision 6 (8.7%)
Amputation 2 (2.9%)
Hardware infection 2 (2.9%)
Partial flap loss 2 (2.9%)
Flap loss 0 (0.0%)
Ambulation status*
Fully ambulatory 24 (35.3%)
Assistance device 24 (35.3%)
Wheelchair 20 (29.4%)

*15 patients had no long-term follow-up after discharge.

Figure 1. Duration of time until independent ambulation among patients who received soleus flap.

literature suggesting that smoking increases infectious complications in plastic surgery patients [13,14] .
Furthermore, 66.7% of patients who required flap revisions smoked tobacco - a known vasoconstrictor and
[15]
deterrent to wound healing . Interestingly, in our study, high severity GA fracture classification was not
significantly correlated with infection (P = 0.304), despite 56 patients having open lower extremity fractures
and GA fracture classification being a strong predictor of deep infections . However, our cohort
[16]
demonstrated that significantly more patients with high-grade GA injuries suffered middle-third leg
wounds (P = 0.009), prompting soleus flap allocation.

Four of the twelve (33.3%) patients who suffered infectious complications had concurrent remote fractures,
likely reflective of higher impact MOI, and, subsequently, a higher likelihood of infection based on
increased injury severity. GA can be used as a surrogate for injury severity [16,17] ; notably, our data did not
demonstrate significance between GA classification and the need for flap revision (P = 0.599), possibly
reflective of a small number of revisions (8.7%); notably, four of six patients requiring revision had GA type