Soft Tissue Coverage in Distal Lower Extremity Open Fractures: Comparison of Free Anterolateral Thigh and Free Latissimus Dorsi Flaps
25 March 2017
24 August 2017
27 October 2017 (eFirst)
Background When microsurgical transfers are required in posttraumatic lower limb reconstruction, surgeons must choose among many types of free flaps. Historically, surgeons have advocated muscular flaps for coverage of open lower extremity wounds, but fasciocutaneous free flaps are now often used with good results. This study aimed to compare the functional and aesthetic outcome of reconstruction by free muscular latissimus dorsi (LD) flap and free fasciocutaneous anterolateral thigh (ALT) flap used for soft tissue coverage of distal lower extremity open fractures.
Methods We performed a single-center, retrospective study of subjects with distal lower limb open fractures treated with LD flaps or ALT flaps between 2008 and 2014. Patients with limited follow-up or incomplete data were excluded from the analysis. Donor and recipient sites, early complications and long-term outcomes (functional and aesthetic) were studied and compared according to the type of flap.
Results A total of 47 patients were included: 27 patients in the LD flap group and 20 patients in the ALT flap group. No significant difference was found regarding early and late complications and long-term functional outcomes (bone healing, infectious bone complications, flap healing). As for aesthetic outcome and donor-site morbidity, reconstruction using the ALT free flap had significantly better results (p < 0.05).
Conclusions In posttraumatic lower limb injury, either LD or ALT free flaps can be used for wound coverage with comparable long-term functional outcomes. The ALT flap provides better cosmetic results than LD.
Keywordsanterolateral thigh flap - latissimus dorsi flap - free flap - lower limb - open tibial fracture - open foot fracture
There is no funding source.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1 Heller L, Levin LS. Lower extremity microsurgical reconstruction. Plast Reconstr Surg 2001; 108 (04) 1029-1041 , quiz 1042
- 2 Yazar S, Lin CH, Lin YT, Ulusal AE, Wei FC. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg 2006; 117 (07) 2468-2475 , discussion 2476–2477
- 3 Chan JK, Harry L, Williams G, Nanchahal J. Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps. Plast Reconstr Surg 2012; 130 (02) 284e-295e
- 4 Gosain A, Chang N, Mathes S, Hunt TK, Vasconez L. A study of the relationship between blood flow and bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg 1990; 86 (06) 1152-1162 , discussion 1163
- 5 Paro J, Chiou G, Sen SK. Comparing muscle and fasciocutaneous free flaps in lower extremity reconstruction–does it matter?. Ann Plast Surg 2016; 76 (Suppl. 03) S213-S215
- 6 Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, Scalea T. Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma 2009; 66 (05) 1311-1314
- 7 Demirtas Y, Kelahmetoglu O, Cifci M, Tayfur V, Demir A, Guneren E. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery 2010; 30 (01) 24-31
- 8 Park JE, Rodriguez ED, Bluebond-Langer R. , et al. The anterolateral thigh flap is highly effective for reconstruction of complex lower extremity trauma. J Trauma 2007; 62 (01) 162-165
- 9 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24 (08) 742-746
- 10 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78 (03) 285-292
- 11 Hallock GG. Utility of both muscle and fascia flaps in severe lower extremity trauma. J Trauma 2000; 48 (05) 913-917
- 12 Nelson JA, Fischer JP, Haddock NT. , et al. Striving for normalcy after lower extremity reconstruction with free tissue: the role of secondary esthetic refinements. J Reconstr Microsurg 2016; 32 (02) 101-108
- 13 Xiong L, Gazyakan E, Kremer T. , et al. Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety. Microsurgery 2016; 36 (06) 511-524
- 14 Byrd HS, Cierny III G, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg 1981; 68 (01) 73-82
- 15 Byrd HS, Spicer TE, Cierney III G. Management of open tibial fractures. Plast Reconstr Surg 1985; 76 (05) 719-730
- 16 Karanas YL, Nigriny J, Chang J. The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery 2008; 28 (08) 632-634
- 17 Starnes-Roubaud MJ, Peric M, Chowdry F. , et al. Microsurgical lower extremity reconstruction in the subacute period: a safe alternative. Plast Reconstr Surg Glob Open 2015; 3 (07) e449
- 18 Kimura N, Satoh K. Consideration of a thin flap as an entity and clinical applications of the thin anterolateral thigh flap. Plast Reconstr Surg 1996; 97 (05) 985-992
- 19 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
- 20 Duffy Jr FJ, Brodsky JW, Royer CT. Preliminary experience with perforator flaps in reconstruction of soft-tissue defects of the foot and ankle. Foot Ankle Int 2005; 26 (03) 191-197
- 21 Kotick JD, Mitchell W, Bayouth L, Klein R, Lee K. Repeated elevation of the anterolateral thigh flap for lower extremity orthopedic trauma does not affect flap viability. J Reconstr Microsurg 2016; 32 (03) 189-193
- 22 Wong CH, Ong YS, Wei FC. The anterolateral thigh-vastus lateralis conjoint flap for complex defects of the lower limb. J Plast Reconstr Aesthet Surg 2012; 65 (02) 235-239