Bone exposure in the leg: is a free muscle flap mandatory?
BACKGROUND
In lower leg defects with bone, hardware, or articular exposure, a free tissue transfer is often the only valuable option. However, in well-selected clinical cases, pedicled flaps are still indicated because they provide an alternative for the more demanding and risky microsurgical procedure. The medial adipose-fascial flap of the leg represents an ideal local regional fascial flap.


METHODS
Twenty-two medial adipose-fascial flaps (performed in 21 patients) were reviewed retrospectively and compared with a series of 22 free gracilis flaps (22 patients) selected out of 150 muscular free flaps for lower leg reconstruction. All patients with defects larger than 40 cm, peripheral vascular disease, deep defects, and osteomyelitis were excluded in order to obtain the same surgical indications in which the local medial adipose-fascial flap could have been used.


RESULTS
The overall surgical results were comparable, but more medical complications, a longer operative time, and a longer hospital stay were seen in the free muscle group. Moreover, patients reconstructed with a medial adipose-fascial flap appeared to be more satisfied with the aesthetic result of their reconstruction.


CONCLUSIONS
Muscle coverage is not mandatory to cover bone in the lower leg. The medial adipose-fascial flap can provide a good alternative for free flap coverage. This flap seems to have fewer medical complications, requires a shorter operative time and hospital stay, and can provide better aesthetic results than a free muscle flap.
Department of Plastic and Reconstructive Surgery, CHU Sart Tilman, University of Liège, Liège, Belgium.
Nicolas
N
Verhelle
Jan
J
Vranckx
Bert
B
Van den Hof
Olivier
O
Heymans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery; D005260:Female; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013524:Surgical Flaps