Abstract
Background Free tissue transplantations are commonly used to treat complex lower extremity defects
caused by trauma, vascular disease, or malignancy, particularly when vital structures
are exposed. This study aimed to expand the knowledge on patient-reported outcomes
by comparing fasciocutaneous and muscle flaps, with the goal of facilitating patient
counseling. Additionally, patient-level risk factors associated with decreased functioning
and health-related quality of life were identified.
Methods This retrospective, cross-sectional, multicenter study included patients who underwent
microsurgical lower extremity reconstruction using free fasciocutaneous or muscle
flaps between 2003 and 2021, with a minimum follow-up of 12 months. Data were collected
from medical records, pain scores, Short-Form 36 (SF-36), and Lower Extremity Functional
Scale (LEFS). Mean scores were compared between flap types and predictors of LEFS,
SF-36 mental component summary (MCS), and SF-36 physical component summary (PCS) scores
were determined using a backward stepwise regression model.
Results Of the 206 patients eligible, 100 (49%) were included in the retrospective part.
A total of 89 (43%) responded to the questionnaires, with 62 treated using a fasciocutaneous
flap and 27 with a muscle flap. No significant differences in total LEFS, SF-36 PCS,
or MCS scores were found between the two flap type. Pain was a significant predictor
of decreased functional outcomes for both flap types and was also linked to poorer
mental health in patients treated with fasciocutaneous flaps. Other predictors of
low patient-reported outcome scores included obesity, diabetes, poorer mental health,
and a follow-up of less than 2 years.
Conclusion Patients treated with fasciocutaneous and muscle flaps experience comparable levels
of functionality and quality of life after surgery. Flap selection should be based
on defect characteristics, along with the surgeon's individual skills and preferences.
A comprehensive approach that considers physical comorbidities, pain, and mental health
is essential, as these factors significantly impact patient functionality and quality
of life.
Keywords
lower leg - free flap - reconstruction
