A nomogram for predicting free flap necrosis in soft tissue reconstruction of lower limbs: a retrospective cohort study
By
Cong Cheng
Xiaoyu Huang
Hai Liang
Zongyuan Jiang
May 26, 2026
Clinical Scorecard: Development of a Nomogram to Assess the Risk of Free Flap Necrosis in Lower Limb Soft Tissue Reconstruction: A Retrospective Analysis
At a Glance
Category Detail
Condition Free flap necrosis in lower limb soft tissue reconstruction Key Mechanisms Independent risk factors identified include Gustilo-Anderson classification, preoperative D-dimer, preoperative albumin, operative time, and defect size. Target Population Patients undergoing free flap reconstruction for lower limb soft tissue defects Care Setting Single-center, retrospective cohort study
Key Highlights
Five independent risk factors identified for free flap necrosis. Nomogram demonstrated an optimism-corrected AUC of 0.87 in the training cohort. Excellent calibration and clinical utility shown in decision curve analysis. Guideline-Based Recommendations
Diagnosis
Utilize the nomogram for risk prediction in patients undergoing free flap reconstruction. Management
Consider identified risk factors in preoperative assessment and planning. Monitoring & Follow-up
Monitor patients with high-risk factors closely for signs of flap necrosis. Risks
Free flap necrosis occurs in 8-15% of cases, leading to prolonged hospital stays and increased healthcare costs. Patient & Prescribing Data
220 patients who underwent free flap reconstruction between January 2010 and March 2025.
Risk factors include Gustilo-Anderson classification IIIB/IIIC, preoperative D-dimer > 0.5 mg/L, preoperative albumin < 35 g/L, operative time > 6 h, and defect size > 50 cm2.
Clinical Best Practices
Incorporate the nomogram into clinical practice for risk stratification. Address systemic factors such as hypoalbuminemia and hypercoagulable states preoperatively. Related Resources & Content
