Annual Meeting Home
Final Program
Past & Future Meetings


Back to Annual Meeting Program

Muscle Versus Skin or Perforator Flaps for Limb Salvage in War Trauma: Is There a Difference?
Jennifer Sabino, MD1, Mark Shashikant, MD2, Ian L. Valerio, MD, MS, MBA1.
1Walter Reed National Military Medical Center, Bethesda, MD, USA, 2Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.

Background: Evolving management of combat-related extremity injuries has resulted in increased limb salvage opportunities. The nearly decade long Iraq and Afghanistan Wars have also presented military surgeons with soft tissue coverage challenges in patients who often have multiple injuries which can limit options for availability of known reconstructive workhorse flaps. The purpose of this study is to investigate our collective experience and compare outcomes for muscle and skin based flaps.
Methods: A multicenter retrospective review of injured Servicemembers treated with soft tissue transfer for limb reconstruction from 2003 through 2012 was completed. Data collected included patient demographics, flap location and type. Outcomes measured included complications such as hematoma and flap infection and total or partial flap loss, and extremity complications such as soft tissue infection and osteomyelitis, and failed limb salvage.
Results: Over the last decade, 350 flap procedures (215 pedicle, 135 free) were performed on 188 lower and 132 upper extremities (30 extremities underwent multiple procedures). Patients were mostly males, aged 17-63, with a mean injury severity score (ISS) of 18. A total of 98% of patients were followed with average follow-up of 26 months.
Flap Options
n (%)n (%)n (%)
Total194 (55)Total147 (42)Total9 (3)
Free64 (33)Free64 (44)Free7 (78)
Latissimus45 (70)Anterolateral thigh (ALT)35 (54)Pedicle2 (22)
Rectus12 (19)Lateral arm15 (23)
Serratus3 (5)Scapular11 (17)
Pedicle130 (67)Pedicle83 (56)
Gastrocnemius62 (48)Sural21 (26)
Soleus34 (26)Groin19 (23)
Latissimus18 (14)Radial forearm8 (10)

n (%)n (%)P-value
Total53 (27)37 (25)0.375
Flap infection15 (8)8 (5)0.271
Hematoma/seroma12 (6)9 (6)0.584
Flap Failure26 (13)11 (7)0.035
Free Flaps8 (13)3 (5)0.103
Pedicle Flaps18 (14)7 (8)0.164
Soft tissue Infection28 (14)18 (12)0.337
Osteomyelitis29 (15)13 (9)0.061
Amputation30 (15)17 (11)0.191

Conclusion: In nearly a decade of war trauma, our multicenter group has performed a high volume of complex extremity reconstructions. We present a broad range of flap options to provide adequate coverage in extremity salvage and will discuss our institutional algorithms for optimal flap selection in our patient population. Complication rates did not significantly differ between the muscle and skin/perforator-based flap groups. However, failure rates were significantly higher in the muscle group which may mean that while complication rates were not statistically different they were clinically different. Though there was no difference in failure rates when broken down into free and pedicle flap subgroups. Further investigation is warranted to determine the cause of the increased failure rate in muscle based flaps. Nonetheless, each of these flap categories has utility in our patients, but each must be carefully considered prior to transfer based on reconstructive and rehabilitation goals of our war wounded.

Back to Annual Meeting Program


© 2024 Northeastern Society of Plastic Surgeons. All Rights Reserved. Privacy Policy.