TY - JOUR
T1 - Comparing Outcomes for Fasciocutaneous versus Muscle Flaps in Foot and Ankle Free Flap Reconstruction
AU - Lee, Z. Hye
AU - Abdou, Salma A.
AU - Daar, David A.
AU - Anzai, Lavinia
AU - Stranix, John T.
AU - Thanik, Vishal
AU - Levine, Jamie P.
AU - Saadeh, Pierre B.
N1 - Publisher Copyright:
© 2019 Georg Thieme Verlag. All rights reserved.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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.
KW - fasciocutaneous flaps
KW - foot and ankle reconstruction
KW - free flap
KW - lower extremity
KW - muscle flaps
KW - plantar reconstruction
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U2 - 10.1055/s-0039-1691785
DO - 10.1055/s-0039-1691785
M3 - Article
C2 - 31146290
AN - SCOPUS:85073310981
SN - 0743-684X
VL - 35
SP - 646
EP - 651
JO - Journal of Reconstructive Microsurgery
JF - Journal of Reconstructive Microsurgery
IS - 9
ER -