Comparing Muscle and Fasciocutaneous Free Flaps in Lower Extremity Reconstruction—Does It Matter?

Abstract

Our data suggest that in essentially all clinical parameters, there is no difference between free flap type used for soft tissue coverage of the lower extremity. Patients undergoing reconstruction with a fasciocutaneous flap may return to weight bearing earlier--although they are more likely to require elective flap revisions. These results imply essentially equivalent outcomes regardless of flap type or operative indication, in contrast with some of the biases in the orthopedic community. The particular flap chosen for any reconstruction should remain solely at the discretion of the plastic surgeon.

Evaluation of 389 patients following free‐flap lower extremity reconstruction with respect to secondary refinement procedures

“…However, no selection bias toward a specific flap type could be demonstrated with regarding patient weight in our study. In contrast to the reports from Paro, Chiou, and Sen () who compared 86 muscle versus 35 fasciocutaneous free flaps in lower extremity reconstruction and showed an increased rate of secondary procedures in fasciocutaneous flaps, our data did not exhibit this relationship, although a trend toward more fasciocutaneous flaps, in particular ALT flaps, was seen in cohort 2. One possible explanation may be the primary careful thinning and trimming of all of our fasciocutaneous flaps during the initial free‐flap reconstructive procedure to fit the recipient site in size and shape.…”

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

“…Previously reported flaps used for local coverage of deep shoulder wounds following rotator cuff repair include the latissimus dorsa and pectorals major, both of which have been reported to have favourable outcomes [29][30][31]. Modern reconstructive literature indicates that utilization of well vascularized fasciocutaneous flaps is equivalent to use of a muscle flap for wound coverage, and the choice of the regional flap is at the discretion of the reconstructive surgeon [32][33][34][35][36].…”

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

“…Moreover, muscle flaps may limit tendon gliding and their elevation for secondary surgeries (i.e., tenolysis) is harder [51] . Most commonly used muscle flaps are, according to many authors, latissimus dorsi, serratus anterior, rectus abdominis and gracilis [56][57][58] . The latissimus dorsi presents many advantages and it is a considered a "workhorse" flap.…”