Background Lower extremity reconstruction often requires soft tissue transfer for limb salvage. Flaps are allocated based on injury size, location, and shape coupled with surgeon expertise. Ideally, vascularized tissue should have similar outcomes across local and free tissue transfers. By evaluating outcomes from a Level 1 trauma center, we aim to provide recommendations regarding surgical management of leg reconstruction with respect to local versus free flap implementation. Methods This retrospective review evaluated patient medical history, demographics, flap characteristics, and outcomes from LAC + USC between 2007-2021 using an internal database. Outcomes included failure rates, complications, and ambulation. Results 357 lower extremity flaps were placed on 322 patients; 187 (52.4%) were local and 170 (47.6.%) were free flaps. Twenty-one (11.2%) local flaps suffered significantly more postoperative hardware infections and/or osteomyelitis compared to nine (5.3%) free flaps. Eleven (5.9%) local flaps developed partial necrosis, four requiring revision; 12 (6.4%) total local flaps required revision. Comparatively, sixteen (9.4%) free flaps developed partial necrosis, seven requiring revision; 18 (10.6%) total free flaps required revision. Flap survival was 96.3% for local versus 93.5% for free flaps. Percentage of fully ambulatory patients and time to final ambulation was not significant across cohorts. Discussion Local flaps may portent higher risk for infection; though the cause is not clear, the results may be confounded by comorbidities. Nevertheless, there were no significant differences in flap survival or number of fully ambulatory patients across cohorts. Future studies should evaluate aesthetic results and patient satisfaction across flap types.
plastic surgery residency. Significant increases are especially encountered for select case categories. Prospective applicants can make informed decisions on the utility of this approach when pursuing fellowship training.
Aim: Soleus muscle flaps have traditionally been a reliable tool in the plastic surgeon’s armamentarium for lower extremity reconstruction and limb salvage. In the modern era, many surgeons prefer free flaps. This study sought to evaluate trends and outcomes of soleus flap reconstruction after lower extremity injury in a large cohort at a Level 1 trauma center. Methods: This is an Institutional Review Board -approved, retrospective chart review that was undertaken at Los Angeles County + University of Southern California Medical Center from 2007 to 2021. Patient demographics, Gustilo-Anderson fracture classification, flap characteristics, and outcomes were collected and analyzed. Outcomes of interest included failure rates, postoperative complications, and long-term ambulatory status. Results: Of 187 local leg flaps, 68 (36.4%) were soleus flaps, with 84% of soleus flaps performed prior to 2016. The flap loss rate was 0.0%. Eighteen (26.1%) flaps demonstrated > 1 complication, including osteomyelitis/hardware infection (n = 12), flap revision (n = 6), and amputation (n = 2). Long-term follow-up demonstrated 35.3% of patients ambulating independently after an average of 7.5 ± 7.2 months, with the remainder needing a wheelchair or walking assistance device. Conclusion: Although soleus flap loss rate was 0%, the findings demonstrate more infections than expected; this must be considered in light of pre-existing patient comorbidities possibly deterring free flap placement. Additionally, our results reveal that only 16% of soleus flaps were performed after 2015. As surgeons consider the reconstructive ladder for lower extremity trauma, a rotational soleus muscle flap should not be overlooked in the modern era of free flap tissue transfers and might be a more optimal flap choice in certain patients with multiple comorbidities.
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