AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Past & Future Meetings


Back to Annual Meeting Posters


Flap Options for Limb Salvage: The Increased Use of Skin/Perforator Flaps
Jennifer Sabino, MD1; Ian L. Valerio, MD, MS, MBA1; Mark Shashikant, MD2; (1)Walter Reed National Military Medical Center, (2)Fort Belvoir Community Hospital
Jennifer Sabino, Bethesda, MD, USA

Background: Operations Iraqi Freedom, Enduring Freedom, and New Dawn have presented military surgeons with limb salvage opportunities. Patients have multiple injuries which can limit flap options in the face of large zones of injury and limited tissue availability. When choosing an appropriate flap for reconstruction, surgeons have to taking into account the need for prompt and effective rehabilitation. 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 for extremity injuries from 2003 through 2012 was completed. Data collected included location and flap type. Outcomes measured included complications such as infection and total or partial flap loss, extremity complications, and failed limb salvage.

Results: Over the last decade, 359 flap procedures (216 pedicle and 143 free flaps) were performed. Patients were mostly males, aged 17-63, with a mean injury severity score (ISS) of 18. The median number of days to definitive flap procedure and number of procedures prior to flap were 19 days and 5 procedures, respectively.

Flap Options

Muscle

Skin/Perforator

Other

n (%)

n (%)

n (%)

Total

197 (55)

Total

152 (42)

Total

10 (3)

Free

67 (19)

Free

68 (19)

Free

8 (2)

Latissimus

48 (13)

Anterolateral thigh (ALT)

38 (11)

Pedicle

2 (1)

Rectus

12 (3)

Lateral arm

15 (4)

Serratus

3 (1)

Scapular

14 (4)

Pedicle

130 (36)

Pedicle

84 (23)

Gastrocnemius

62 (17)

Sural

21 (6)

Soleus

35 (10)

Groin

21 (6)

Latissimus

18 (5)

Radial forearm

8 (2)

Complications

Muscle

Skin/Perforator

n

%

n

%

P-value

Total

56

16

39

11

0.325

Flap Failure

26

7

11

3

0.018

Soft tissue Infection

28

8

18

5

0.314

Osteomyelitis

29

8

13

4

0.055

Amputation

30

8

17

5

0.174

Conclusion: In 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. Skin and perforator flaps perform as well if not better than traditional muscle flaps while sparing core muscle in patients requiring intense rehabilitation. Each must be carefully considered prior to transfer based on reconstructive and rehabilitation goals of our war wounded. However, further study is necessary to determine long term functional outcomes.


Back to Annual Meeting Posters

 

© 2020 American Association for Hand Surgery. Privacy Policy.