Muscle/musculocutaneous versus fasciocutaneous free flap reconstruction in the lower extremity: A systematic review and meta‐analysis

Abstract

Background Free flaps for soft tissue coverage of the lower extremity can be broadly divided into muscle/musculocutaneous and fasciocutaneous flaps. The purpose of this systematic review and meta‐analysis was to assess their different post‐operative outcomes. Methods A systematic search was performed in PubMed, Scopus, and the Web of Science from their inception to February 2022. Non‐randomized comparative studies, which describe any post‐operative outcome of muscle/musculocutaneous and fasciocutaneous free flaps reconstruction in the lower extremity were included. Articles with duplicate titles, editorials, review articles, case series, case reports, and publications lacking an abstract, those reporting pediatric patients, those describing only muscle/musculocutaneous or fasciocutaneous free flaps, those with incomplete or incomparable post‐operative outcomes, and studies involving <10 muscle/musculocutaneous or fasciocutaneous free flaps were excluded. A comparative meta‐analysis was conducted on muscle/musculocutaneous and fasciocutaneous free flaps outcomes, comprising vascular thrombosis, partial or complete flap necrosis, infection, donor‐site complications, non‐union, and primary or recurrent osteomyelitis. The fixed‐effects meta‐analysis model was used when low heterogeneity (I2 < 50%) was identified. Results Twenty‐two articles with a total of 2711 flaps (1584 muscle/musculocutaneous flaps and 1127 fasciocutaneous flaps) were included in the qualitative and quantitative assessment. The rates of any flap necrosis (12.0% vs. 7.4%; p = 0.007) and donor‐site complications (16.7% vs. 6.7%; p < 0.0001) were significantly higher for muscle/musculocutaneous flaps than for fasciocutaneous flaps. There were no significant differences in the rates of vascular thrombosis (10.5% vs. 10.7%; p = 0.98), complete flap necrosis (6.2% vs. 4.7%; p = 0.30), infection (19.4% vs. 14.7%; p = 0.18), non‐union (18.9% vs. 14.8%; p = 0.33), and primary or recurrent osteomyelitis (14.7% vs. 12.4%; p = 0.69). Conclusion This meta‐analysis revealed no significant difference in long‐term post‐operative outcomes, but suggested that fasciocutaneous flaps should be preferred to avoid flap necrosis and donor‐site complications.

The evolution of pediatric soft‐tissue free flap reconstruction of the lower extremity after oncologic resection: A 30 year experience

“…Most of these patients received neoadjuvant or adjuvant chemotherapy or radiation, a factor which may have potentiated this problem (Cannon et al, 2006;Hassan et al, 2022). Flap success rate was 95%, which is in concordance with rates in the adult population (L opez et al, 2015;Shimbo et al, 2022). In terms of functional outcomes, the majority were able bear full weight on the affected limb, participate in ADLs, and ambulate independently.…”

Microvascular Soft Tissue Reconstruction Outcomes and Risk Factors in Pediatric Patients Undergoing Head and Neck Reconstruction

“…A similar trend is seen in the adult population which leans toward utilizing fasciocutaneous flaps over free muscle flaps for both head and neck and lower limb reconstruction. [26][27][28] This preference arises from the broader range of applications fasciocutaneous flaps offer, including their suitability for mucosal lining and pharyngeal defects, their less bulky nature, resistance to fluctuations in weight, and their ability to yield enhanced esthetic outcomes at the donor site. [29][30][31]…”

Muscle versus Fascia Free Tissue Transfer for Treatment of Chronic Osteomyelitis in the Comorbid Population

“…29 Additionally, our results support previous systematic reviews suggesting muscle flaps result in similar rates of osteomyelitis recurrence compared with fasciocutaneous free flaps. 14,30 Although these reviews included heterogeneous populations of acute and chronic osteomyelitis of various traumatic and atraumatic etiologies, the alignment of these results specific to the chronic LE wound population indicates that the physiologic composition of free flaps likely do not influence delayed recurrence rates. Our study further strengthens this finding through the inclusion of multivariate analysis to account for previously identified risk factors for osteomyelitis development, upon which the results remained true.…”