Skin Paddles Improve Muscle Flap Salvage Rates After Microvascular Compromise in Lower Extremity Reconstruction
John T. Stranix, MD, Adam Jacoby, MD, Z-Hye Lee, MD, Lavinia Anzai, MD, Vishal Thanik, MD, Jamie P. Levine, MD, Pierre B. Saadeh, MD.
New York University, New York, NY, USA.
Purpose: Free tissue transfer after lower extremity trauma is associated with high complication rates. The inclusion of a cutaneous paddle on muscle free flaps may improve clinical flap monitoring. The effect of skin paddle presence on muscle free flap salvage outcomes after takeback was examined.
Methods: Retrospective query of our institutional free flap registry (1979-2016) identified 362 muscle-based flaps performed for soft tissue coverage following below knee trauma. Primary outcome measures were perioperative complications, specifically takeback indications, timing, and flap salvage rates. Univariate and multivariate regression analysis was performed where appropriate.
Results: The most common flaps were latissimus dorsi (166, 45.9%), rectus abdominis (123, 34%), and gracilis (42, 11.6%) with 90 flaps (24.9%) including skin paddles. Takebacks for vascular compromise occurred in 44 flaps (12.2%), of which 39% contained a skin paddle while 61% did not. Muscle flaps with skin paddles were more likely to return to the operating room within 48 hours postoperatively than those without (57.1% vs. 18.2%, p=0.036). After takeback, significantly more muscle flaps with skin paddles were salvaged compared with muscle flaps without paddles (35.7% vs. 4.5%, p=.024). Similarly, more muscle-only flaps after takeback failed compared with their counterparts with skin paddles (95.5% vs 65.3%, p =.024).
Conclusions: Muscle flaps with a cutaneous paddle were associated with earlier return to the operating room and more successful flap salvage after takeback compared to muscle-only flaps. These findings suggest that skin paddle presence may improve clinical flap monitoring and promote recognition and treatment of microvascular compromise in lower extremity reconstruction.
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