Evaluating Outcomes of Lower Extremity Free Tissue Transfer: Are Muscle Flaps Better Than Skin Flaps?
Eugenia H. Cho, BS1, Andrew R. Bauder, MD1, Ronnie L. Shammas, BS2, Stephen J. Kovach, III, MD1, Scott T. Hollenbeck, MD, FACS2, L. Scott Levin, MD, FACS1.
1University of Pennsylvania, Philadelphia, PA, USA, 2Duke University, Durham, NC, USA.
PURPOSE: Clinical indications are expanding for the use of fasciocutaneous free flaps in complex lower extremity traumatic reconstruction. We assessed outcomes of muscle versus fasciocutaneous free flap coverage for acute and chronic traumatic defects.
METHODS: All patients who underwent lower extremity traumatic free flap reconstruction at Duke University (1997-2013) and the University of Pennsylvania (2002-2013) were retrospectively identified. Reconstructive and functional outcomes of muscle versus fasciocutaneous free flaps were analyzed in two subgroups: 1) acute trauma ≤30 days before reconstruction; and 2)osteomyelitis, non-union, and chronic traumatic wounds.
RESULTS: A total of 438 patients underwent lower extremity traumatic free flap reconstruction with 264 muscle flaps and 174 fasciocutaneous flaps (Figure 1). Muscle and fasciocutaneous flap groups did not differ in flap complication rates, amputation, or time to ambulation (Table 1). Muscle flaps were more commonly performed for acute traumatic injuries, compared to chronic wounds (p<0.01). Fasciocutaneous flaps were favored for foot wounds (p<0.01), whereas muscle flaps were favored for tibial wounds (p<0.01), Gustilo grade IIIb injuries (p<0.01), and wounds with exposed hardware/bone/tendon (p=0.03). Intraoperatively, fasciocutaneous flaps were associated with lower estimated blood loss (p<0.01). Increasing 17-year trends were noted in the use of fasciocutaneous flaps (p<0.01).
CONCLUSION: The use of muscle versus fasciocutaneous free flaps for lower extremity traumatic reconstruction achieved similar reconstructive and functional outcomes. Flap selection should be guided by defect characteristics and reconstructive needs.
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