K. G. Kim1, M. Mishu2, E. G. Zolper1, P. Bhardwaj2, A. Rogers1, K. L. Fan1, K. K. Evans1 1MedStar Georgetown University Hospital,Department Of Plastic & Reconstructive Surgery,Washington, DC, USA 2Georgetown University School of Medicine,Washington, DC, USA
Introduction
Good nutritional status is essential for proper wound healing. Postoperatively, free tissue transfer (FTT) patients are in a hypermetabolic state. Thus, optimizing nutritional status is critical to maximize flap success and healing. Historically, prealbumin and albumin have been utilized as easily obtained proxies for overall nutritional status, indicating acute and chronic changes, respectively. The aim of this study was to investigate whether these markers are correlated with healing time and overall flap healing after lower extremity (LE) FTT in the chronic wound population.
Methods
A retrospective review of LE chronic wound FTT patients treated by a single surgeon at our institution from 2011-2020 was performed. Inclusion criteria was defined as (1) albumin within 30 days prior to FTT, (2) prealbumin within 3 days prior to FTT, and (3) documented follow-up. Data collection included demographics, comorbidities, flap characteristics, and perioperative labs. The outcomes of interest were flap healing (FH) and time to flap healing (TFH). Patients were stratified according to perioperative nutritional markers, using initial thresholds of albumin <3.5 g/dL and prealbumin <10 mg/dL for poor nutritional status. Additional analysis at various thresholds for albumin and prealbumin was performed. Fisher’s exact testing was used to assess overall healing rates and Mann-Whitney testing was used to assess association between perioperative nutritional markers and TFH.
Results
We identified 69 patients undergoing LE FTT for limb salvage with a mean age of 56.0 years (standard deviation [SD] 12.1). Mean Charlson Comorbidity Index was 3.4 (SD 2.1) and median follow up was 11.1 months. When using a threshold of <3.5 g/dL for low albumin, no significance was found between FH or TFH and preoperative albumin, preoperative prealbumin, or postoperative albumin (Table 1). With low albumin defined as <2.8 g/dL, TFH was significantly increased and FH was significantly decreased compared to the defined normal preoperative albumin group (Table 1). No significance was found between FH or TFH and preoperative prealbumin or postoperative albumin. An independent prealbumin threshold of < 20 mg/dL did not cause significant change in outcomes.
Conclusion
Low preoperative albumin, when defined as <3.5 g/dL, and prealbumin did not increase TFH. Contrarily, when defined as <2.8 g/dL, low preoperative albumin significantly increased TFH and FH rates. The reliability of albumin and prealbumin as markers for nutritional status, however, has come into question. Further investigation into validated biomarkers and their thresholds is needed to assess the effect of nutritional status on wound healing and guide perioperative optimization.
