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A Systematic Review of Muscle and Fasciocutaneous Flaps in the Treatment of Extremity Osteomyelitis: Evidence for Fasciocutaneous Flap Use

Kovar, Alexandra MD; Colakoglu, Salih MD; Iorio, Matthew L MD

Plastic and Reconstructive Surgery – Global Open: July 2019 - Volume 7 - Issue 7S - p 1-2
doi: 10.1097/01.GOX.0000579788.48949.1a
Mountain West 2019 Abstract Supplement

University of Colorado, Aurora, CO

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

BACKGROUND: Limb salvage in the setting of extremity osteomyelitis, though previously dependent on amputation, has been markedly improved through the application of free tissue flaps. Concern exists as to the utility of the fasciocutaneous flap to combat infection verses the traditional muscle flap. Prior studies have shown success with fasciocutaneous flaps in these patients, but given the small series, the choice remains controversial. The goal of this paper was to determine if there is statistical evidence for flap choice in the setting of extremity osteomyelitis.

METHODS: A systematic review utilizing PRISMA guidelines was completed of the current literature pertaining to treatment of extremity osteomyelitis and flap reconstruction within the MedLine and PubMed databases. 619 studies were reviewed and ultimately 25 were included in the final analysis.

RESULTS: 513 flap reconstructions were identified. Of the 451 muscle flaps, 8.9% (N=40) had recurrence of osteomyelitis after an average of 37.7 (12.3–111.6) month follow-up. There were no cases of osteomyelitis recurrence in the 62 fasciocutaneous flap group (p = 0.009) after an average of 28.8 (18.2–43) month follow-up. Secondary outcomes such as flap loss, hematomas, and infection were analyzed without statistically significant differences between the muscle and fasciocutaneous flap groups.

CONCLUSION: Selection of flap type is less important than adequate debridement, appropriate antibiotic selection, and sufficient duration of treatment. This study demonstrates that within the literature, fasciocutaneous flaps have a lower recurrence rate of osteomyelitis compared to muscle flaps. As such, fasciocutaneous flaps are appropriate for reconstruction and treatment of extremity osteomyelitis.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.