Utility of both muscle and fascia flaps in severe lower extremity trauma

Background: The evolving technology in trauma management today permits salv age of many severe lower extremity injuries previously even considered to b e lethal. An essential component for any such treatment protocol must be ad equate soft tissue coverage that often will use vascularized flaps. Traditi onally, calf muscles have been used proximally and free flaps for the dista l leg and foot. The reintroduction of reliable local fascia flaps has chall enged this dictum, proving to be a simpler and yet versatile option. Materials and Method: The role of both muscle and fascia flaps in lower ext remity injuries has been retrospectively reviewed from a 2-decade experienc e. Soft tissue deficits requiring some form of vascularized flap occurred i n 160 limbs in 155 patients. The frequency of use of flap types, specific c omplications and benefits, effect of timing of wound closure, and rate of l imb salvage mere compared. Results: Initial coverage after significant lower extremity trauma in these 160 limbs required 60 local muscle flaps, 50 local fascia flaps, and 73 fr ee flaps. These flaps had been selected on a nonrandom basis according to w ound location, its severity, and flap availability. Complications were dire ctly related to the severity of injury, and for free flaps as a group (39%) , although these were not independent variables. Local muscle (27%) or fasc ia flaps (30%) were similar with regard to this morbidity, Healing was more likely to be uneventful if coverage were accomplished during the acute per iod after injury, regardless of flap type. Muscle flaps were still used in two thirds of all cases, with the soleus muscle used as often for the dista l leg as the mid-leg. Local fascia flaps were most valuable for smaller def ects, especially in the distal leg or foot, and often as a reasonable alter native to a free flap. Conclusion: The traditional role of the gastrocnemius muscles for flap cove rage of knee and proximal leg defects and the soleus muscle for the middle third of the leg was reaffirmed. The soleus muscle often also reached dista l leg defects as could local fascia flaps, where classically, otherwise, a free flap would have been necessary. The largest or most severe wounds, irr espective of limb location, required free flap coverage. Local fascia flaps proved to be a valuable alternative.