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J Reconstr Microsurg 2019; 35(09): 646-651
DOI: 10.1055/s-0039-1691785
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction

Z-Hye Lee
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
Salma A. Abdou
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
David A. Daar
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
Lavinia Anzai
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
John T. Stranix
2   Department of Plastic Surgery, University of Virginia Health System, Charlottesville, Virginia, United States
,
Vishal Thanik
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
Jamie P. Levine
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
,
Pierre B. Saadeh
1   Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York, New York, United States
› Author Affiliations
Further Information

Publication History

05 January 2019

15 April 2019

Publication Date:
30 May 2019 (online)

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Abstract

Background The distal lower extremity poses unique reconstructive challenges due to its requirements for durability of the load-bearing plantar surface and for thin, pliable contour in the dorsal foot and ankle region. This study compares outcomes between muscle and fasciocutaneous flaps in patients with foot and ankle defects.

Methods A retrospective review of soft tissue free flaps used for traumatic foot and ankle defects was performed. Outcomes included takebacks, partial flap failure, total flap failure, and wound complications.

Results A total of 165 cases met inclusion criteria, with muscle flaps (n = 110) comprising the majority. Defects involving the non–weight-bearing surface were more common (n = 86) than those of the weight-bearing surface (n = 79). Complications occurred in 56 flaps (33.9%), including 11 partial losses (6.7%) and 6 complete losses (3.6%). There were no differences in take backs, partial flap failure, or total flap failure between muscle and fasciocutaneous flaps; however, fasciocutaneous flaps had significantly fewer wound complications compared with muscle flaps (7.3% vs. 19.1%, p = 0.046). On multivariable regression analysis, defects of the weight-bearing surface had significantly increased risk of wound breakdown compared with those in the non–weight-bearing surface (odds ratio: 5.05, p = 0.004).

Conclusion Compared with fasciocutaneous flaps, muscle flaps demonstrated higher rates of wound complications. While the flap selection in foot and ankle reconstruction depends on the nature of the defect, our findings support the use of fasciocutaneous over muscle flaps in this region.

Keywords

foot and ankle reconstruction - lower extremity - muscle flaps - fasciocutaneous flaps - plantar reconstruction - free flap
 

  • References

  • 1 Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1986; 77 (05) 785-794
    CrossrefPubMedSearch in Google Scholar
  • 2 Harry LE, Sandison A, Pearse MF, Paleolog EM, Nanchahal J. Comparison of the vascularity of fasciocutaneous tissue and muscle for coverage of open tibial fractures. Plast Reconstr Surg 2009; 124 (04) 1211-1219
    CrossrefPubMedSearch in Google Scholar
  • 3 Gosain A, Chang N, Mathes S, Hunt TK, Vasconez L. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1990; 86 (06) 1152-1162 , discussion 1163
    CrossrefPubMedSearch in Google Scholar
  • 4 Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, Scalea T. Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma 2009; 66 (05) 1311-1314
    CrossrefPubMedSearch in Google Scholar
  • 5 Yazar S, Lin CH, Lin YT, Ulusal AE, Wei FC. 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 (07) 2468-2475 , discussion 2476–2477
    CrossrefPubMedSearch in Google Scholar
  • 6 Cho EH, Shammas RL, Carney MJ. , et al. Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis. Plast Reconstr Surg 2018; 141 (01) 191-199
    CrossrefPubMedSearch in Google Scholar
  • 7 Mehta D, Abdou S, Stranix JT. , et al. Comparing radiographic progression of bone healing in Gustilo IIIB open tibia fractures treated with muscle versus fasciocutaneous flaps. J Orthop Trauma 2018; 32 (08) 381-385
    CrossrefPubMedSearch in Google Scholar
  • 8 Yücel A, Senyuva C, Aydin Y, Cinar C, Güzel Z. Soft-tissue reconstruction of sole and heel defects with free tissue transfers. Ann Plast Surg 2000; 44 (03) 259-268 , discussion 268–269
    CrossrefPubMedSearch in Google Scholar
  • 9 Nazerali RS, Pu LL. Free tissue transfer to the lower extremity: a paradigm shift in flap selection for soft tissue reconstruction. Ann Plast Surg 2013; 70 (04) 419-422
    CrossrefPubMedSearch in Google Scholar
  • 10 Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg 2005; 115 (01) 142-147
    PubMedSearch in Google Scholar
  • 11 Bibbo C, Nelson J, Fischer JP. , et al. Lower extremity limb salvage after trauma: versatility of the anterolateral thigh free flap. J Orthop Trauma 2015; 29 (12) 563-568
    CrossrefPubMedSearch in Google Scholar
  • 12 Noever G, Brüser P, Köhler L. Reconstruction of heel and sole defects by free flaps. Plast Reconstr Surg 1986; 78 (03) 345-352
    CrossrefPubMedSearch in Google Scholar
  • 13 Demirtas Y, Kelahmetoglu O, Cifci M, Tayfur V, Demir A, Guneren E. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery 2010; 30 (01) 24-31
    PubMedSearch in Google Scholar
  • 14 Paro J, Chiou G, Sen SK. Comparing muscle and fasciocutaneous free flaps in lower extremity reconstruction--does it matter?. Ann Plast Surg 2016; 76 (Suppl. 03) S213-S215
    CrossrefPubMedSearch in Google Scholar
  • 15 Chan JK, Harry L, Williams G, Nanchahal J. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg 2012; 130 (02) 284e-295e
    CrossrefPubMedSearch in Google Scholar
  • 16 Wyble EJ, Yakuboff KP, Clark RG, Neale HW. Use of free fasciocutaneous and muscle flaps for reconstruction of the foot. Ann Plast Surg 1990; 24 (02) 101-108
    CrossrefPubMedSearch in Google Scholar
  • 17 Chen D, Jupiter JB, Lipton HA, Li SQ. The parascapular flap for treatment of lower extremity disorders. Plast Reconstr Surg 1989; 84 (01) 108-116
    CrossrefPubMedSearch in Google Scholar
  • 18 Fischer S, Klinkenberg M, Behr B. , et al. Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient. J Reconstr Microsurg 2013; 29 (08) 537-544
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Dayan JH, Lin CH, Wei FC. The versatility of the anterolateral thigh flap in lower extremity reconstruction. Handchir Mikrochir Plast Chir 2009; 41 (04) 193-202
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Ring A, Kirchhoff P, Goertz O. , et al. Reconstruction of soft-tissue defects at the foot and ankle after oncological resection. Front Surg 2016; 3: 15
    CrossrefPubMedSearch in Google Scholar
  • 21 Izadi D, Paget JT, Haj-Basheer M, Khan UM. Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconstr Aesthet Surg 2012; 65 (10) 1357-1362
    CrossrefPubMedSearch in Google Scholar
  • 22 Philandrianos C, Moullot P, Gay AM. , et al. Soft tissue coverage in distal lower extremity open fractures: comparison of free anterolateral thigh and free latissimus dorsi flaps. J Reconstr Microsurg 2018; 34 (02) 121-129
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Sabino J, Polfer E, Tintle S. , et al. A decade of conflict: flap coverage options and outcomes in traumatic war-related extremity reconstruction. Plast Reconstr Surg 2015; 135 (03) 895-902
    CrossrefPubMedSearch in Google Scholar
  • 24 Ulusal BG, Lin YT, Ulusal AE, Lin CH, Yen JT. Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: analysis of fifty patients. Microsurgery 2005; 25 (08) 581-588
    CrossrefPubMedSearch in Google Scholar
  • 25 Musharafieh R, Atiyeh B, Macari G, Haidar R. Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases. J Reconstr Microsurg 2001; 17 (03) 147-150
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Rajacic N, Gang RK, Krishnan J, Lal Bang R. Thin anterolateral thigh free flap. Ann Plast Surg 2002; 48 (03) 252-257
    CrossrefPubMedSearch in Google Scholar
  • 27 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Duffy Jr FJ, Brodsky JW, Royer CT. Preliminary experience with perforator flaps in reconstruction of soft-tissue defects of the foot and ankle. Foot Ankle Int 2005; 26 (03) 191-197
    CrossrefPubMedSearch in Google Scholar
  • 29 Pappalardo M, Jeng SF, Sadigh PL, Shih HS. Versatility of the free anterolateral thigh flap in the reconstruction of large defects of the weight-bearing foot: a single-center experience with 20 consecutive cases. J Reconstr Microsurg 2016; 32 (07) 562-570
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Sönmez A, Bayramiçli M, Sönmez B, Numanoğlu A. Reconstruction of the weight-bearing surface of the foot with nonneurosensory free flaps. Plast Reconstr Surg 2003; 111 (07) 2230-2236
    CrossrefPubMedSearch in Google Scholar
  • 31 Heidekrueger PI, Ehrl D, Prantl L. , et al. Microsurgical reconstruction of the plantar foot: long-term functional outcomes and quality of life. J Reconstr Microsurg 2019
    PubMed
  • 32 May Jr JW, Halls MJ, Simon SR. Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study. Plast Reconstr Surg 1985; 75 (05) 627-641
    CrossrefPubMedSearch in Google Scholar
  • 33 May Jr JW, Rohrich RJ. Foot reconstruction using free microvascular muscle flaps with skin grafts. Clin Plast Surg 1986; 13 (04) 681-689
    CrossrefPubMedSearch in Google Scholar
  • 34 Nola GT, Vistnes LM. Differential response of skin and muscle in the experimental production of pressure sores. Plast Reconstr Surg 1980; 66 (05) 728-733
    CrossrefPubMedSearch in Google Scholar
  • 35 Daniel RK, Faibisoff B. Muscle coverage of pressure points--the role of myocutaneous flaps. Ann Plast Surg 1982; 8 (06) 446-452
    CrossrefPubMedSearch in Google Scholar
  • 36 Ninković M, Schoeller T, Benedetto KP, Anderl H. Emergency free flap cover in complex injuries of the lower extremities. Scand J Plast Reconstr Surg Hand Surg 1996; 30 (01) 37-47
    CrossrefPubMedSearch in Google Scholar
  • 37 Rainer C, Schwabegger AH, Bauer T. , et al. Free flap reconstruction of the foot. Ann Plast Surg 1999; 42 (06) 595-606 , discussion 606–607
    CrossrefPubMedSearch in Google Scholar
  • 38 Pollak AN, McCarthy ML, Burgess AR. ; The Lower Extremity Assessment Project (LEAP) Study Group. Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. J Bone Joint Surg Am 2000; 82-A (12) 1681-1691
    PubMedSearch in Google Scholar
  • 39 Hollenbeck ST, Woo S, Komatsu I, Erdmann D, Zenn MR, Levin LS. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125 (03) 924-934
    CrossrefPubMedSearch in Google Scholar
  • 40 Koh K, Goh TLH, Song CT. , et al. Free versus pedicled perforator flaps for lower extremity reconstruction: a multicenter comparison of institutional practices and outcomes. J Reconstr Microsurg 2018; 34 (08) 572-580
    Thieme ConnectPubMedSearch in Google Scholar