Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps.
BACKGROUND
Functional outcomes of lower extremity reconstruction compared with amputation have been evaluated. However, there are little comparative data among the different reconstructive options. With the recent increase in perforator flaps, we compared the functional outcomes of muscle and perforator flaps.


METHODS
We conducted a retrospective review of 136 lower extremity trauma patients who underwent reconstruction with either a free muscle or perforator flap during a 7-year period. Forty-two of these patients completed the study. Patients answered the short musculoskeletal functional assessment form and supplemental questions. A physical therapist evaluated performance of physical tasks. Donor site sensation was measured with the pressure specified sensing device. Radiographic fracture union was evaluated by an orthopedic surgeon.


RESULTS
Of the 42 patients enrolled, 20 had coverage with perforator flaps and 22 with muscle flaps. Quality of life and functional outcomes demonstrate no difference (p > 0.05). Ninety-three percent of patients would go through the limb salvage process to avoid amputation. Sensation at the donor site was diminished in all patients; however, the perforator flap donor site had more significant sensory loss (p = 0.005). Time to bony union (p = 0.51), union in the presence of infection (p = 0.85), and infection after flap (p = 0.87) was not related to flap type.


CONCLUSIONS
Both muscle and perforator flaps provide vascularized coverage, which nourishes the fracture but muscle flaps pilfer a functional unit which may not be inconsequential in a patient trauma. This pilot study suggests that functional outcomes of perforator skin flaps are equal to muscle flaps and a larger prospective study is warranted.
Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. erodriguez@umm.edu
Eduardo D
ED
Rodriguez
Rachel
R
Bluebond-Langner
Carol
C
Copeland
T Nicole
TN
Grim
Navin K
NK
Singh
Thomas
T
Scalea
D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D023821:Limb Salvage / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011336:Probability; D052097:Quadriceps Muscle / Q000098:blood supply / Q000637:transplantation*; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery; D013524:Surgical Flaps; D013848:Thigh; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology