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Bone-based versus soft-tissue free flaps in lower extremity reconstruction.

Keisuke Shimbo1, Rikuo Shinomiya2, Toru Sunagawa2

  • 1Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.

Journal of Orthopaedic Science : Official Journal of the Japanese Orthopaedic Association
|March 25, 2023
PubMed
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Bone-based free flaps and soft-tissue flaps show similar long-term outcomes for lower extremity reconstruction. While bone-based flaps involve more complex surgery, they do not increase postoperative complications, suggesting careful technique can ensure success.

Area of Science:

  • Orthopedic Surgery
  • Reconstructive Surgery
  • Microsurgery

Background:

  • Lower extremity defects require reconstruction using soft-tissue or bone-based free flaps.
  • Large bone defects often necessitate bone-based flaps for successful reconstruction.

Purpose of the Study:

  • To compare bone-based and soft-tissue free flaps in lower extremity reconstruction.
  • To evaluate operative procedures, postoperative complications, and long-term outcomes.

Main Methods:

  • Retrospective cohort study of 122 lower extremity free flap reconstructions (March 2014-February 2022).
  • Data analyzed for operative details, complications, and long-term outcomes (≥12 months follow-up).
  • Classified flaps into bone-based (29) and soft-tissue (93) types, and by etiology (trauma/non-trauma).
Keywords:
Fibula flapFree vascularized bone graftLower extremityReconstruction

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Main Results:

  • No significant difference in postoperative complications or long-term outcomes between bone-based and soft-tissue flaps.
  • Bone-based flaps more frequently required vein grafts (20.7% vs. 7.5%) and anastomosis to superficial veins (37.9% vs. 10.8%).

Conclusions:

  • Bone-based free flaps offer comparable long-term outcomes to soft-tissue flaps in lower extremity reconstruction.
  • Despite more complex procedures, bone-based flaps do not increase complications.
  • Utilizing vein grafts and superficial venous anastomosis may mitigate complications with bone-based flaps.