A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients

Abstract

Objective: Chronic lower extremity (LE) wounds are common in patients with peripheral vascular disease (PVD). Free tissue transfer (FTT) provides healthy soft tissue for wound coverage and additional blood supply to promote wound healing. Given previous studies demonstrate increased complications in LE fasciocutaneous flaps, it was hypothesized that low vascular resistance in muscle flaps may be more advantageous for wound healing in PVD patients. Therefore, this study compared outcomes in PVD patients undergoing LE reconstruction with fasciocutaneous versus muscle free flaps. Methods: Retrospectively reviewed PVD patients undergoing FTT between 2011 and 2021. Patients were stratified into fasciocutaneous and muscle free flap groups. Primary outcomes included complications, flap success, post-reconstruction vascular interventions, limb salvage, and ambulatory status. Results: One hundred thirteen patients with PVD were identified, of which 60.2% received fasciocutaneous (n = 68) and 39.8% received muscle flaps (n = 45). Fortytwo patients (37.2%) underwent pre-flap endovascular interventions. Flap success rate was 98.2% (n = 111). Overall complication rate was 41.2% following fasciocutaneous flaps compared to 24.4% in muscle flaps (p = 0.067). Fasciocutaneous flaps had higher odds of ulceration requiring repeat angiogram within 1 year of reconstruction compared to muscle flaps (OR 3.4, 95%

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

“…Gram negative and other gram positive 8 ( better long-term results in the PVD population. 33 Additionally, fasciocutaneous flaps have provided greater aesthetic results without the need for additional bulking procedures and concomitant skin graft or secondary skin graft procedures. 34,35 In instances of wounds necessitating bulk to fill dead space, muscle flaps may be superior.…”

“…31,32 When faced with peripheral vascular disease, which represented 39.6% of our cohort, our institution previously determined that preoperative endovascular intervention was more pertinent to flap success than flap composition, however muscle flaps conferred better long term results in the PVD population. 33 Additionally, fasciocutaneous flaps have provided greater aesthetic results without the This article is protected by copyright. All rights reserved.…”