Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale

Abstract

Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.

Limb Salvage and Functional Outcomes following Free Tissue Transfer for the Treatment of Recalcitrant Diabetic Foot Ulcers

“…Our institution recently published an article of LEFS survey responses for 101 free flaps for lower extremity reconstruction, concluding that patients are able to independently ambulate and function in the community after FTT. 23 To our knowledge, our current study is the first to publish objective functional outcomes data following FTT in the diabetic limb salvage population. We encourage future studies to implement validated functional outcomes surveys and quality-of-life measures, such as the LEFS and Short Form 36, respectively, to objectively compare outcomes between institutions and populations.…”

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

“…Moreover, few studies used validated scales, such as the LEFS or FAC, to report functional status in a standardized fashion. 14,44,46,50 QOL measures are even less consistently described and are often anecdotal in nature; only one study used a validated scoring system to assess QOL ratings. 37 For patients undergoing LE flap reconstruction, clinical practice has seen a growing shift in focus on long-term outcomes that are patient-centered in nature, such as ambulation and functionality.…”

“…14,31,37,40,44,50,[52][53][54]56,58,[61][62][63] The average LEFS score, calculated from three studies, was 54.4 out of 80 points, indicating stage-4 function, or "independent community ambulation." 14,44,46 The range of LEFS scores was 46 to 65.6, with the highest score reported by Wu et al in a study of local flap outcomes for chronic osteomyelitis of long bones. 14,44,46 The only study to report FAC level, Lim et al calculated a mean level of 5.2 out of 6, corresponding to independent ambulation on level surfaces only.…”

“…14,44,46 The range of LEFS scores was 46 to 65.6, with the highest score reported by Wu et al in a study of local flap outcomes for chronic osteomyelitis of long bones. 14,44,46 The only study to report FAC level, Lim et al calculated a mean level of 5.2 out of 6, corresponding to independent ambulation on level surfaces only. 50 The use of ambulation assistance devices, such as canes and walkers, was described as a functional outcome in four studies.…”

Content Validity of the LIMB-Q: A Patient-Reported Outcome Instrument for Lower Extremity Trauma Patients

“…However, due to limited available instruments, researchers have relied upon ad hoc questionnaires or PRO instruments not developed for this patient population. While these instruments, such as the Sickness Impact Profile, 38 SF-36, 39 PROMIS, 9 American Orthopedic Foot and Ankle Society Ankle-Hindfoot and Midfoot Rating Scales, 40 Short Musculoskeletal Function Assessment Questionnaire, 41 Lower Extremity Functional Scale, 42,43 and Toronto Extremity Salvage Score 44 are frequently utilized, it is not established if they are capturing outcomes identified to be important to patients, that is, content validity has not yet been established. Therefore, despite many authors using PRO instruments to evaluate outcomes in lower extremity trauma patients, it is not without the influence of the clinician or researcher who initially determined what outcomes would be of importance to measure.…”