Reconstructive surgery Risk factors, outcomes and advanced indications

The first part of this thesis investigates outcomes in reconstructive flap surgery using big data analysis. Firstly, outcomes after flap reconstructive surgery for diabetic patients compared to non-diabetic ones, highlighting higher risks of complications for diabetic patients, especially those with insulin-dependent diabetes. Additionally, it examines the impact of age and frailty on postoperative outcomes, emphasizing the importance of considering frailty scores instead of age alone in surgical planning for elderly patients. This thesis also delves into the incidence and risk factors of sepsis following reconstructive flap surgery, revealing significant associations with various patient factors. Moreover, racial disparities in outcomes after breast reconstructive surgery are explored, showing no differences in outcomes between different ethnicities.
In the second part of this thesis, alternative surgical approaches for managing complications post-rectal/pelvic cancer surgery are discussed. These include the use of gluteal turnover flaps for perineal closure and a dorsal approach with partial sacrectomy followed by gluteal V-Y fasciocutaneous advancement flaps for treating chronic pelvic sepsis. Both techniques show promise in reducing complications and promoting wound healing. The effectiveness of gluteal fasciocutaneous flaps in treating chronic pelvic sepsis is highlighted specifically, offering a feasible and successful alternative for patients with limited options due to previous surgeries or (chemo)radiotherapy. Limitations of the studies, such as their retrospective nature and diverse patient populations, are acknowledged throughout.