Muscle versus fasciocutaneous flaps in fracture healing: A scoping review of basic science evidence

Open extremity fractures with extensive soft tissue damage may require reconstruction with a soft tissue flap. While either muscle or fasciocutaneous flaps may be used, clinical studies have not definitively determined which results in lower infection rates. Therefore, we aimed to review the basic science literature on muscle and fasciocutaneous flaps to identify translational evidence supporting the use of one flap type over another for extremity reconstruction.

We conducted a scoping review of PubMed, Embase, Scopus, and Web of Science to identify non-clinical studies of soft tissue reconstruction for fractures or other osseous defects. Outcomes of interest included vascularity, infection, and biomechanical strength, as well as the molecular and cellular characteristics of the healed bone.

We included 19 studies. Eleven studies reported exclusively on muscle flaps, and 8 studies compared muscle and fasciocutaneous flaps. Most studies modeled extremity fractures. Fractures managed with muscle flaps demonstrated enhanced angiogenesis, fewer infections, greater biomechanical strength, increased stem cell recruitment, and greater growth factor concentration compared to fasciocutaneous flaps.

The basic science literature suggests that muscle flaps are superior to fasciocutaneous flaps across several key outcomes pertaining to traumatic lower extremity fractures. These findings underscore the discrepancy between basic science and clinical evidence and emphasize the need for prospective clinical trials on flap reconstruction that control for injury severity.