Outcome comparison between muscle and fasciocutaneous flaps after secondary orthopedic procedures. J Plast Reconstr Aesthet Surg 2023 Feb;77:111-116
Date
12/24/2022Pubmed ID
36563636DOI
10.1016/j.bjps.2022.11.036Scopus ID
2-s2.0-85145732657 (requires institutional sign-in at Scopus site) 1 CitationAbstract
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.
Author List
Guo M, Thomas B, Goyal S, Rivedal D, Mehdi M, Schmeling GJ, Neilson JC, Martin J, Harkin EA, Wooldridge A, King DM, Hackbarth DA Jr, Doren EL, Hettinger P, LoGiudice JAAuthors
Erin L. Doren MD Associate Professor in the Plastic Surgery department at Medical College of WisconsinDavid M. King MD Chair, Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
John C. Neilson MD Associate Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
Elizabeth A. Nolte MD Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
David Rivedal MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin
Gregory J. Schmeling MD Vice Chair, Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
Adam Neal Wooldridge MD, MPH Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Free Tissue FlapsHumans
Muscles
Orthopedic Procedures
Retrospective Studies
Surgical Flaps
Treatment Outcome
