Factors associated with failed hardware salvage in high-risk patients after microsurgical lower extremity reconstruction

BACKGROUND: Lower extremity hardware salvage remains challenging in patients with complex comorbidities. The purpose of this study was to identify factors associated with failed hardware salvage after microsurgical lower extremity reconstruction. METHODS: A retrospective, institutional review board-approved review was performed of patients who underwent lower extremity hardware salvage via free tissue transfer from 2004 to 2010. Outcomes were binarized into successful versus failed hardware salvage, with failure defined as nonelective removal. Patient demographics, wound characteristics, microbiology, and pathology were compared. RESULTS: Thirty-four patients underwent lower extremity hardware salvage via free tissue transfer, with an average follow-up of 3.2 years (range, 0.3-7.0 years). Of these patients, 15 (44.1%) had successful hardware salvage and 19 (55.9%) required hardware removal. By demographics, a higher prevalence of multiple comorbidities was found in patients with failed hardware salvage. Wound characteristics revealed a significantly longer time to hardware coverage and longer duration of intravenous antibiotics in failed versus successful hardware salvage patients (38.9 vs 9.3 weeks, P = 0.02; 6.5 vs 4.1 weeks, P = 0.03, respectively). Initial wound cultures demonstrated a significantly higher frequency of positive growth in patients with failed versus successful hardware salvage (100.0% vs 57.1%, P = 0.003). Initial pathology revealed a borderline-significantly higher frequency of chronic osteomyelitis in failed versus successful salvage patients (66.7% vs 33.3%, P = 0.08). CONCLUSIONS: In this retrospective review of microsurgical lower extremity reconstruction, factors associated with failed hardware salvage included multiple comorbidities, longer time to hardware coverage, increased duration of intravenous antibiotics, positive initial wound cultures, and chronic osteomyelitis on initial pathology.