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Skin or Muscle?: Use of Fasciocutaneous Flaps for Salvage of Acute Open Extremity Fractures
Farrah C. Liu, B.S., Erica Y. Xue, M.S., Paul J. Therattil, M.D., Haripriya Ayyala, M.D., Edward S. Lee, M.D., Jonathan D. Keith, M.D., F.A.C.S.
Rutgers New Jersey Medical School
2018-02-07
Presenter: Farrah C. Liu
Affidavit:
I certify that the material presented in the abstract is original and has not been presented at a major meeting or published in a scientific journal.
Director Name: Edward S. Lee
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: The optimal timing of post-traumatic extremity reconstruction and ideal type of flap coverage remain a topic of debate. The aim of this study was to demonstrate the efficacy of free fasciocutaneous flaps for wound reconstruction in the setting of acute extremity trauma as well as the safety of flap re-elevation during revision surgery.
METHODS: A retrospective review of a single-center's experience with ALT flap reconstruction for acute trauma was performed. Patient were identified from the senior surgeon's prospective database. Charts were reviewed for relevant risk factors, operative details, and outcomes.
RESULTS: Fourteen patients underwent reconstruction with a total of 14 ALT free flaps. Mean patient age and BMI in our series was 39.4 years and 28.3 kg/m2. The average defect size was 311 cm2. Mean time from initial injury to flap reconstruction was 19.4 days, and mean time from flap reconstruction to final surgery was 117.8 days. Patients underwent an average of 4.2 debridements prior to flap reconstruction, and 7.4 surgeries total from initial injury to final surgery. Six flaps were re-elevated 10 times (1 to 4 re-elevations per flap) with no complications following flap re-elevation.
CONCLUSIONS: Extremity reconstruction with fasciocutaneous flaps is a safe option for acute traumatic wounds, even with subsequent flap re-elevation during revision surgery. Despite operating on a Western population with an overweight BMI, it was possible to utilize fasciocutaneous flaps for reconstruction. The optimal time from the initial injury to flap reconstruction may be longer than once thought.
