A Retrospective Comparative Functional and Aesthetic Outcome Study of Muscle versus Cutaneous Free Flaps for Distal Upper Extremity Reconstruction

Abstract

Background Function and cosmesis are crucial in upper extremity reconstruction. Yet, there persists a lack of outcome evaluations, particularly regarding differences between free flap types. Methods In a single-center retrospective analysis, outcomes were compared between patients with cutaneous or muscle free flaps for distal upper extremity reconstruction between 2008 and 2018. The Disabilities of Arm, Shoulder and Hand -Score, Michigan-Hand (MHQ), and Short Form 36 Health Survey (SF-36) Questionnaires were assessed, motor function was quantified, and self-reported measures of cosmesis were compared, including the Vancouver Scar-Scale (VSS), MHQ aesthetics-subscale (MAS), and Moscona's cosmetic validation-score (CVS). Results One-hundred forty-one cases were identified, with a shift toward cutaneous flaps over the study period. Muscle flaps were used for larger defects (251 vs. 142 cm2, p = 0.008). Losses, thromboses, and donor-site complications were equally distributed. Partial necroses were more frequent in muscle flaps (11 vs. 1%, p = 0.015). Seventy patients with 53 cutaneous versus 17 muscle flaps were reexamined. There was no difference in the timing of flap coverage (after 16 vs. 15 days, p = 0.79), number of preceding (2 vs. 1.7, p = 0.95), or subsequent operations (19/53 vs. 5/17, p = 0.77). Patients with cutaneous flaps showed higher grip strength (25 vs. 17 kg, p = 0.046) and reported better hand function (MHQ: 58 vs. 47, p = 0.044) and general health (SF-36: 70 vs. 61, p = 0.040), as well as more favorable appearance (MAS: 71 vs. 57, p = 0.044, CVS: 77 vs. 72, p = 0.048), and scar burden (VSS: 0 vs. 3, p < 0.001). Conclusion Cutaneous flaps yielded better motor function, self-perceived cosmesis, patient satisfaction, and quality of life in our cohort of distal upper extremity reconstructions.

A single‐center retrospective comparison of Duplex ultrasonography versus audible Doppler regarding anterolateral thigh perforator flap harvest and operative times

“…To this end, perforator flaps offer certain advantages that have contributed to their growing success over the past decades (Morris et al, 2010). Particularly in extremity reconstruction, the anterolateral thigh perforator (ALT) free flap has gained widespread popularity in this context, due to its easily accessible donor site, relatively long pedicle, reliable perforasome, and pliability (Thomas et al, 2021;Wei et al, 2002).…”

Do the Histological Differences of Soft Tissue Sarcomas Affect the Rate of Skin Defect Reconstruction?

“…For the proximal side of the thigh, pedicled RAM was the most commonly used, consistent with the reports in the literature 31 . Contrarily, distal limb reconstructions were usually performed with free flaps 32,33 . In the free flap, the donor site of the flap was decided according to the operator's preference.…”

“…31 Contrarily, distal limb reconstructions were usually performed with free flaps. 32,33 In the free flap, the donor site of the flap was decided according to the operator's preference. We preferred free ALT because this flap has the advantage of a long vascular pedicle with large-caliber vessels and is suitable as a flow-through flap and thin flap.…”

Reconstruction of Hand and Foot Defects with Free Serratus Carpaccio Flap and Free Serratus Fascia Flap: A Comparative Retrospective Study of Surgical Outcomes

“…While established muscle and fasciocutaneous flaps have been used for extremity reconstructions and have demonstrated comparable results in limb salvage [32,33], recent studies have shown that fasciocutaneous flaps have fewer wound healing disorders and partial flap losses [34,35]. During the decision-making process, the reconstructive microsurgeon must consider various factors when selecting a flap, such as its ability to withstand mechanical stress and remain thin and pliable to ensure mobility.…”