Comparison of the Outcomes of Perforator-Based Adipofascial Flaps and Local Muscle Flaps in Distal Lower Extremity Reconstruction: A Retrospective Study.

Abstract

Introduction: Soft tissue reconstruction in the distal lower extremities is challenging because of the inherent vulnerability of tendons, bones, and implants to being easily exposed, and scanty local tissue makes it more complicated. Local flaps that avoid the donor-site morbidity and the need of microsurgery gain popularity among the treatment choices. This study aims to compare the outcomes of 2 common local flaps: adipofascial flaps and muscle flaps in distal lower leg reconstruction.

Materials and methods: From November 2019 to November 2023, the patients with distal lower leg defects undergoing perforator-based adipofascial flaps or muscle flaps were included and reviewed. The patient demographics, injury characteristics, outcomes, and complications were evaluated.

Results: A total of 32 patients were included in the study of which, 17 received perforator-based adipofascial flaps, and 15 received muscle flaps. The backgrounds of the 2 groups were similar, except that the patients in the adipofascial flap group were older and had more comorbidities. All flaps survived except for one muscle flap that failed. The flap survival, infection rates, and donor-site complications were comparable in both groups; however, the adipofascial flap group had less daily drainage volume and seemed to have a shorter hospital stay, although the difference was not significant (8.06 ± 3.33 days vs 11.93 ± 7.63 days, P = 0.085).

Conclusions: For distal lower leg reconstruction, the adipofascial flaps are comparable to the muscle flaps but avoid the functional impairment. If available, the adipofascial flap can be considered as a prior treatment option, even for patients with implant exposure.