Optimal assessment of MGMT status as a prognostic biomarker for patients with newly diagnosed GBM treated with chemoradiation requires determination of both promoter methylation and IHC protein expression.

Background There are many factors to consider when choosing between amputations versus salvage in lower extremity reconstructive surgery. Postoperative functionality and survival benefit are critical factors when deciding between limb salvage and amputation. Methods In this review, we present the evidence and the risks and benefits between these two options in the setting of the acute, trauma population and the chronic, diabetes population. Results The trauma population is on average young without significant comorbidities and with robust vasculature and core strength for recovery. Therefore, these patients can often recover significant function with anamputation and prosthesis. Amputation can therefore be the more desirable in this patient population, especially in the case of complete traumatic disruption, unstable patients, high risk of extensive infection, and significant nerve injury. However, traumatic lower extremity reconstruction is also a viable option, especially in the case of young patients and those with intact plantar sensation and sufficient available tissue coverage. The diabetic population with lower extremity insult has on average a higher comorbidity profile and often lower core strength. These patients therefore often benefit most from reconstruction to preserve limb length and improve survival. However, amputation may be favored for diabetics that have no blood flow to the lower extremity, recalcitrant infection, high-risk comorbidities that preclude multiple operations, and those with end stage renal disease. Conclusion Many patient-specific factors should be considered when deciding between amputation vs. salvage in the lower extremity reconstruction population.

Introduction The thigh has been called the reconstructive warehouse. The anterolateral thigh (ALT) and vastus lateralis (VL) flaps are popular options for free tissue transfer in lower extremity reconstruction. We sought to review the largest experience of these flaps in the chronic wound population. Methods We retrospectively reviewed patients who underwent lower extremity reconstruction using ALT or VL flaps by a single surgeon between 2012 and 2018. Results Fifty ALT and 34 VL flaps were identified. Comorbidities were similar between groups with the exception of body mass index (ALT, 26.8; VL, 30.1; P = 0.0121). There was also a significant difference rate of independent ambulation preoperatively (ALT, 98.0%; VL, 85.3%; P = 0.0375). An adjunct was needed for recipient site coverage in 31.5% (19/50) of ALT patients and 100% (34/34) of VL patients. Of the patients who received skin grafts, delayed placement was more frequent in the ALT (53.3%) versus VL cohort (18.2%) (P = 0.0192). Median graft take and the rate of skin graft revision were not statistically different. Flap success rates were similar: ALT, 92.0%; and VL, 94.1%. Overall complication rates were not significantly different: ALT, 26.0%; and VL, 38.2%. Infectious complications were also comparable. Subsequent debulking procedures were performed on 8.0% of ALT flaps and 11.8% VL flaps (P = 0.7092). Limb salvage rates were similar between both cohorts (ALT, 82.0%; VL, 88.2%). Ambulation rate was significantly higher for the ALT cohort at 92.0% compared with 73.5% for the VL cohort (P = 0.0216). Median follow-up was similar for both groups. Conclusions We present the largest comparison study of ALT and VL flaps in lower extremity salvage. Complication rates, flap success, and limb salvage were similar between the 2 cohorts. Despite a high prevalence of osteomyelitis in both cohorts, there was no difference in infectious complications. Although the need for skin grafting remains an inherent disadvantage of the VL flap, a significant proportion of ALT recipients also needed an adjunct for recipient site coverage. Ambulation rate was significantly greater in the ALT group. However, flap type was no longer significant for ambulation when controlling for preoperative ambulatory status.