Free Vastus Lateralis Muscle vs Anterolateral Thigh Flaps for Coverage of Lower Extremity Defects in the Chronic Wound Population: A Comparison of Early and Late Outcomes
Cara K. Black, B.A.1, Elizabeth G. Zolper, B.S.2, Kenneth L. Fan, M.D.2, Laurel D. Ormiston, M.S.1, Jonathan A. Schwitzer, M.D.2, Kyle Luvisa, M.P.H.1, Karen Kim Evans, M.D.2.
1Georgetown University School of Medicine, Washington, DC, USA, 2MedStar Georgetown University Hospital, Washington, DC, USA.
Introduction: The anterolateral thigh(ALT) flap and vastus lateralis(VL) flaps are popular options for free tissue transfer(FTT) in lower extremity(LE) reconstruction. With our large experience using thigh-based flaps for LE reconstruction in the chronic wound, we sought to compare outcomes of the two procedures.
Methods: We retrospectively reviewed patients in whom FTT using ALT vs. VL
was performed by a single surgeon between 2012 and 2018.
Results: 65 ALT and 34 VL flaps were identified. Comorbidities (age, BMI, hypertension, peripheral vascular disease, and end stage renal disease) were similar between groups (p>0.05) with the exception of diabetes types I and II (ALT 33.9%, VL 55.9%, p=0.0345). Flap success rates were also similar: 90.8% and 94.1% for ALT and VL flaps, respectively(p>0.05). Complication rates of 30.8% among ALT and 17.7% among VL flaps were not significantly different (p>0.05). Subsequent debulking procedures were performed on 7.7% of ALT flaps and 8.8% VL flaps(p>0.05). Limb salvage rates were 86.1% for ALT and 88.2% for VL cohorts (p>0.05). Ambulation rate was significantly higher for the ALT cohort at 90.8% (mean follow-up of 1.36 years) compared to 73.5% for the VL cohort (mean follow-up of 1.19 years) (p=0.0231).
Conclusions: We present the largest comparison study of ALT and VL flaps in LE salvage. Complication rates, flap success, and limb salvage were similar between the two cohorts. Notably, the ambulation rate was significantly greater in the ALT group at 90.8% (p<0.05).
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