Choosing between Muscle and Fasciocutaneous Free Flap Reconstruction in the Treatment of Lower Extremity Osteomyelitis: Available Evidence for a Function-Specific Approach

Abstract

Background Limb salvage in the setting of extremity osteomyelitis, though previously dependent on amputation, has been markedly improved through the application of free tissue flaps. Concern exists as to the utility of the fasciocutaneous flap to combat infection verses the traditional muscle flap. Prior studies have shown success with fasciocutaneous flaps in these patients, but given the small series, the choice remains controversial. The goal of this article was to determine if there is statistical evidence for flap choice in the setting of extremity osteomyelitis. Methods A systematic review utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was completed of the current literature pertaining to the treatment of extremity osteomyelitis and flap reconstruction within the MedLine and PubMed databases. Six hundred forty-six studies were reviewed and ultimately 31 were included in the final analysis. Results Eight hundred seventy-eight flap reconstructions were identified. Of the 588 muscle flaps, 7.8% (n = 46) had recurrence of osteomyelitis after an average of 36.1 (8.0–111.6) months follow-up. There were seven cases (4.3%) of osteomyelitis recurrence in the 163 fasciocutaneous flap group after an average of 29.8 (18.2–44.6) months follow-up (p = 0.165). Secondary outcomes such as flap loss, hematomas, and infection were analyzed without statistically significant differences between the muscle and fasciocutaneous flap groups. Conclusion Selection of flap type is less important than adequate debridement, appropriate antibiotic selection, and sufficient duration of treatment. This study demonstrates that within the literature, fasciocutaneous flaps have a lower recurrence rate of osteomyelitis compared with muscle flaps. As such, fasciocutaneous flaps are appropriate for reconstruction and treatment of extremity osteomyelitis.

MRI Manifestations and Diagnostic Value of Chronic Osteomyelitis

“…Vancomycin has an incomparable effect in the treatment of Gram-positive cocci. In recent years, it has been used more and more in the treatment of bone infections [18][19][20]. It basically treats all pathogens that may cause chronic osteomyelitis.…”

A Structured, Microsurgical Training Curriculum Improves the Outcome in Lower Extremity Reconstruction Free Flap Residency Training: The Ludwigshafen Concept

“…Fasciocutaneous flaps, with its vast application opportunities have evolved into workhorse flaps for soft tissue reconstruction after trauma, showed lower recurrence rates after osteomyelitis and lower complication rates compared with muscle flaps for lower extremity reconstruction. 20,21 The study underlines the relevance of fasciocutaneous flap and is the reason why it is indicated as the workhorse flap for extremity reconstruction in our department. Approximately 54% of all free flaps of cohort A and 33% of cohort B were ALT flaps.…”

Modified lateral gastrocnemius myocutaneous flap with extended anterior and/or inferior boundary

“…The important characteristics of osteomyelitis are recurrent infection and resistance to treatment. The recurrence rate of osteomyelitis is an important index to evaluate the effectiveness of surgery, and it is 4.3% ~ 28% as reported in the literature 27 , 28 . In this series, all defects were associated with various degrees of osteomyelitis.…”