J reconstr Microsurg
DOI: 10.1055/s-0039-1698469
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Choosing between Muscle and Fasciocutaneous Free Flap Reconstruction in the Treatment of Lower Extremity Osteomyelitis: Available Evidence for a Function-Specific Approach

Alexandra Kovar
1  Division of Plastic and Reconstructive Surgery, Anschutz Medical Center, University of Colorado, Aurora, Colorado
,
Salih Colakoglu
1  Division of Plastic and Reconstructive Surgery, Anschutz Medical Center, University of Colorado, Aurora, Colorado
,
Matthew L. Iorio
1  Division of Plastic and Reconstructive Surgery, Anschutz Medical Center, University of Colorado, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

02 January 2019

27 August 2019

Publication Date:
07 October 2019 (online)

Abstract

Background Limb salvage in the setting of extremity osteomyelitis, though previously dependent on amputation, has been markedly improved through the application of free tissue flaps. Concern exists as to the utility of the fasciocutaneous flap to combat infection verses the traditional muscle flap. Prior studies have shown success with fasciocutaneous flaps in these patients, but given the small series, the choice remains controversial. The goal of this article was to determine if there is statistical evidence for flap choice in the setting of extremity osteomyelitis.

Methods A systematic review utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was completed of the current literature pertaining to the treatment of extremity osteomyelitis and flap reconstruction within the MedLine and PubMed databases. Six hundred forty-six studies were reviewed and ultimately 31 were included in the final analysis.

Results Eight hundred seventy-eight flap reconstructions were identified. Of the 588 muscle flaps, 7.8% (n = 46) had recurrence of osteomyelitis after an average of 36.1 (8.0–111.6) months follow-up. There were seven cases (4.3%) of osteomyelitis recurrence in the 163 fasciocutaneous flap group after an average of 29.8 (18.2–44.6) months follow-up (p = 0.165). Secondary outcomes such as flap loss, hematomas, and infection were analyzed without statistically significant differences between the muscle and fasciocutaneous flap groups.

Conclusion Selection of flap type is less important than adequate debridement, appropriate antibiotic selection, and sufficient duration of treatment. This study demonstrates that within the literature, fasciocutaneous flaps have a lower recurrence rate of osteomyelitis compared with muscle flaps. As such, fasciocutaneous flaps are appropriate for reconstruction and treatment of extremity osteomyelitis.

Disclosures

The authors did not receive any funding for this study. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.