D132. The Impact of Perioperative Transfusion on Flap Survival in Lower Extremity Trauma

PURPOSE: Blood transfusion may be life-preserving and necessary for adequate flap perfusion for hemorrhaging trauma patients. Limited literature exists regarding the relationship between blood transfusions and flap complications in the trauma setting. This study evaluates the effect of blood transfusions on postoperative flap complications in traumatic lower extremity (LE) reconstruction. METHODS: This retrospective review identified patients who underwent microsurgical LE reconstruction following trauma at a level I trauma center from 2007-2022. Clinical, perioperative, and blood transfusion data since admission were collected. Flap complications included flap revisions, partial flap necrosis, and flap loss. Chi-squared test, independent t-test, and multiple logistical regression were used to analyze the collected data. RESULTS: Upon review, 350 LE flaps were performed, of which 147 received blood transfusions (Tf+) and 203 received no blood transfusions (Tf-). Compared to the Tf- cohort, significantly more flaps in the Tf+ cohort suffered from partial flap necrosis (12.3% vs 5.9%, p=0.034), flap loss (7.5% vs 2.9%, 0.049), and any flap complication (21.2% vs 11.8%, p=0.016). Overall flap survival across both cohorts was 95.1%. Upon logistic regression, blood transfusion status (odds ratio [OR]: 2.13; p=0.027) and female gender (OR: 2.27; p=0.036) were identified as independent predictors of any flap complication. Follow-up time was 4.3±8.2 months across both cohorts. CONCLUSION: Our study determined that perioperative blood transfusion resulted in a higher incidence of postoperative partial-to-full flap necrosis. These results indicate that the decision to transfuse should be made cautiously and strategically, limiting transfusion to only life-threatening cases to minimize morbidity and flap loss.