Muscle versus Fasciocutaneous Flap in Lower Limb Reconstruction: Is There a Best Option?

Abstract

Soft tissue defects of the lower extremity that expose underlying bones, joints, and tendons pose challenging problems and generally require free tissue transfer for a successful reconstruction. Historically, muscle flaps were the gold standard choice for lower limb reconstruction. To obviate the unpredictable appearance and high donor-site morbidity of muscle flaps, fasciocutaneous flaps were introduced. Recently, perforator flaps, such as the anterolateral thigh flap, gained a leading role in the reconstructive scenario. There is growing evidence in the literature supporting that fasciocutaneous and perforator flaps are comparable to muscle flaps in terms of flap survival, postoperative infection, osteomyelitis, bone union, and ambulation. With the advances of knowledge in perforator anatomy and their mapping, a new era of lower limb reconstruction has begun. Propeller flap could be raised on any suitable perforator vessel and, without the aid of microsurgical anastomosis, used to restore small- to middle-sized soft tissue defects. In this review, we intend to analyze pros and cons of muscle and fasciocutaneous free flaps and the applicability of the propeller flaps in lower limb reconstruction

Outcomes of Free Muscle Flaps versus Free Fasciocutaneous Flaps for Lower Limb Reconstruction following Trauma: A Systematic Review and Meta-Analysis

“…The ease and reliability of reelevating fasciocutaneous free flaps for tendon repairs, delayed nerve repair, bone grafting, or secondary hardware orthopaedic procedures was also reflected in the literature and the articles reviewed in this study. 23,30,38,69 Finally, surgeons should also consider functional outcome, impact, and aesthetic appearance when selecting a flap. There was no significant difference between flap types when assessing physical or social functional outcomes, emotional well-being, general health, or employment rates between either flap types, 26,38 which is consistent with the literature.…”

Soleus Muscle Flap Application for Reconstruction of the Middle Third of the Leg

“…One of the best options for regional reconstruction is the use of muscle flaps, due to its ability to cover injuries, increase local circulation and fight infections [3]. The muscle also provides a good environment for osteogenesis, because of the expression of transforming growth factor-β (TGF-β), interleukine-6 (IL-6) and fibroblast grow factor-2 (TNF-2) [4,5]. Another option is the fasciocutaneous flap, that is less invasive than the muscle flap and has higher blood flow and tissue oxygen tension.…”

“…Besides that, primary closure of the donor site is allowed in most of the cases [12]. If all of these flaps were compared, fasciocutaneous and perforator propeller flap provide a relative facility of elevation if a secondary procedure was necessary [5], but muscle flaps are still the best option for covering leg wounds.…”

Soft Tissue Coverage for Defects around the Knee Joint

“…2 3 Studies also have indicated there is no difference whatsoever in terms of healing or functional outcome between these two types of flaps in trauma. 4…”