Summary
Lower extremity wounds associated with fractures and bony defects often require secondary
orthopedic procedures after flap coverage has been performed. In this study, we compare
complications between muscle and fasciocutaneous flaps after secondary orthopedic
procedures. A retrospective chart review study of all lower extremity soft tissue
reconstructions by a single surgeon over seven years yielded a subgroup of patients
who underwent secondary orthopedic procedures, including hardware removal, hardware
revision, and bone grafting after flap reconstruction. Of 355 lower extremity, soft
tissue reconstructions for orthopedic coverage performed in the time period studied,
102 patients underwent secondary orthopedic procedures after flap reconstruction.
Of these, 54 received muscle flaps (52.94%), and 48 received fasciocutaneous flaps
(47.06%).
Using this subgroup of 102 patients, we compared muscle and fasciocutaneous flaps
using three categories of wound complications following these secondary procedures:
There were no superficial wounds requiring local wound care only in the muscle flap group (0%, n = 0) versus 4.17% (n = 2; p = 0.130) in the fasciocutaneous flap group. There were 2 lost flaps requiring surgical debridement and additional skin grafting in the muscle flaps group (3.70%) versus 2 (4.17%; p = 0.904) in the fasciocutaneous flap group. In the third category, flap loss requiring additional soft tissue reconstruction was 18.52% (n = 10) in the muscle group versus 2.08% (n = 1; p = 0.008) in the fasciocutaneous flap group.
Our data support the existing literature indicating that fasciocutaneous flaps can
tolerate secondary procedures better than muscle flaps and should initially be considered
in patients with higher probability of needing additional orthopedic procedures after
reconstruction.
Keywords
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References
- Complications following limb-threatening lower extremity trauma.J Orthop Trauma. 2009; 23: 1-6
- Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps.Plast Reconstr Surg. 1986; 77: 785-794
- Use of muscle flap in chronic osteomyelitis: experimental and clinical correlation.Plast Reconstr Surg. 1978; 62: 162
- Free tissue transfer to the lower extremity: a paradigm shift in flap selection for soft tissue reconstruction.Ann Plast Surg. 2013; 70: 419-422
- The fasciocutaneous flap: its use in soft tissue defects of the lower leg.Br J Plast Surg. 1981; 34: 215-220
- Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity.Microsurgery. 2010; 30: 24-31
- An evidence-based approach to lower extremity acute trauma.Plast Reconstr Surg. 2011; 127: 926-931
- Noncontiguous and open fractures of the lower extremity: epidemiology, complications, and unplanned procedures.Injury. 2016; 47: 742-747
- Preliminary experience with perforator flaps in reconstruction of soft-tissue defects of the foot and ankle.Foot Ankle Int. 2005; 26: 191-197
- Comparing outcomes for fasciocutaneous versus muscle flaps in foot and ankle free flap reconstruction.J Reconstr Microsurg. 2019; 35: 646-651
- Utility of both muscle and fascia flaps in severe lower extremity trauma.J Trauma. 2000; 48: 913-917
- Free flap reconstruction of the foot.Ann Plast Surg. 1999; 42 (discussion 606-597): 595-606
- Free tissue transfers for reconstruction of weight- bearing heel defects: flap selection, ulceration management, and contour revisions.J Plast Reconstr Aesthet Surg. 2021;
- Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps.Plast Reconstr Surg. 2012; 130: 284-295
- Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures.Plast Reconstr Surg. 2009; 124: 1211-1219
- Comparing muscle and fasciocutaneous free flaps in lower extremity reconstruction–does it matter?.Ann Plast Surg. 2016; 76: S213-S215
- Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis.Plast Reconstr Surg. 2018; 141: 191-199
- Comparison of patient satisfaction with aesthetic outcomes following lower extremity reconstruction: muscle vs. fasciocutaneous free flaps.J Plast Reconstr Aesthet Surg. 2021; 74: 65-70
- Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures.Plast Reconstr Surg. 2006; 117: 2468-2475
Article info
Publication history
Published online: November 23, 2022
Accepted:
November 17,
2022
Received:
April 25,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
