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Greater flap failure rate in muscle-based flaps in a postwar Iraq trauma cohort

In a multicenter retrospective chart review of servicemembers treated for extremity injuries from 2003 through 2012, flap failure rates were significantly higher in the muscle-based flap cohort of patients compared to fasciocutaneous flaps.

Three hundred and nine patients with 359 flap procedures were divided into two cohorts based on those undergoing muscle flaps or fasciocutaneous/perforator flaps.

Researchers examined flap success rates, limb salvage success rates and rates of complications, such as infection, total or partial loss, osteomyelitis, extremity complications and failed limb salvage necessitating amputation.

In total, 55% of flaps were muscle flaps and 42% were fasciocutaneous. The number of procedures performed before and after flap transfer varied in muscle flaps, at five versus seven, and in fasciocutaneous/perforator flaps at four versus three, respectively.

Flap failure rate was significantly higher in the muscle cohort (13%) compared with the fasciocutaneous/perforator cohort (6%).

Researchers found no other difference in overall complications between groups.

The most common cause of flap failure was total necrosis secondary to venous thrombosis or flap or flap infection.

Less than 1% of patients needed amputation from flap failure.

The median time to union in the muscle flap cohort was 193 ± 159 days and in the fasciocutaneous/ perforator flap cohort, 115 ± 98 days, according to the study.

Based on individual wounding patterns, flap availability for reconstruction and rehabilitation goals, certain flaps outperform others, according to researchers.

Skin-based and perforator flaps are most often used over muscle flaps for various extremity reconstructions in the researchers' practice, as core strength and accessory muscle groups are unaffected, which aid in the rehabilitation needs of poly-limb injured and/or amputees, according to researchers.

"...Each of these flap categories has utility in our patients, but each must be carefully considered before transfer based on reconstructive and rehabilitation goals of our war-wounded patients with multiple limb injuries or amputations," the researchers wrote. - by Abigail Sutton

Disclosures: The authors reported no financial disclosures.