A Retrospective Comparative Study between Muscle Flaps and Fasciocutaneous Flaps in Reconstruction of Chronic Osteomyelitis Related Wounds of the Lower Limb in the Adult Population

Abstract

Introduction: Chronic osteomyelitis cases are challenging, as they require a multidisciplinary approach for reconstructive soft tissue coverage and orthopedic management. Proper debridement, stable coverage and effective antibiotic therapy are mandatory before application of flap coverage. Patients and Methods:We performed a retrospective comparative study between muscle and fasciocutaneous flaps used for coverage of chronic osteomyelitis related wounds of the lower limb. It included thirty patients who finished a 12 months of follow-up to assess the complications rate and the outcome of surgery. Color match, texture match and aesthetic satisfaction were compared between the 2 groups.Results: Thirty-one flaps including six free flaps and twenty-five local flaps were used to treat these cases. Complications included fluid collections in one case, sinus formation in two 2 cases, partial flap loss in one case. These complications were managed by prolonged antibiotic therapy and dressing changes. Cases in group B had higher scores (mean: 9.5±1.34) in comparison with cases in group A (mean: 7.25±1.29). Yet, there were no statistically significant differences between the 2 groups (p-value: 0.27). Conclusion:A multidisciplinary team is needed for management of cases with chronic osteomyelitis related wounds. Flap coverage can be achieved with either muscular or fasciocutaneous flaps with comparable successful rates.

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

“…Successful osteomyelitis clearance following reconstruction is difficult to definitively declare due to quiescent phases as well as variation in symptomatology and duration, ultimately leading to high relapse rates. 26 Current clinical evidence assessing recurrence in the literature is limited to heterogeneous patient populations and operative indications, as exemplified by the aforementioned study by Khatter et al 19 However, the recurrence rate observed in the current study remained comparable to the traumatic population and higher than heterogenous populations. 21,27,28 One reason for this is that the current study encompasses solely high-risk patients as diabetes and PVD elevate risk of recurrence.…”

“…[15][16][17][18] A review of the literature revealed only Khatter et al directly compares outcomes in patients who receive muscle or fasciocutaneous flaps for LE soft tissue coverage with chronic osteomyelitis, in which the authors report comparable complication rates and aesthetic results. 19 However, this study consisted of a limited traumatic patient population, and notably did not report on the efficacy of the two flap types in achieving limb salvage, ambulation, or osteomyelitis recurrence rates. Additional studies looking at the traumatic patient population showed that there were no significant differences in between muscle and fasciocutaneous free flaps.…”