“40 Years of Lower Extremity Takebacks: Flap Type Influences Salvage Outcomes”

Background: Considering muscle has higher metabolic demand than fasciocutaneous tissue and can be more difficult to monitor clinically, we compared takeback salvage rates between fasciocutaneous and muscle free flaps for lower extremity trauma reconstruction. Methods: Retrospective review of 806 free flaps (1979-2016); 481 soft tissue flaps performed for below knee trauma met inclusion criteria. Primary outcome measures were perioperative complications, specifically takebacks and flap salvage rates. Univariate and multivariate regression analysis was performed where appropriate. Results: Takebacks occurred in 71 flaps (muscle = 44, fasciocutaneous = 27); at an average of 3.7±5.4 days postoperatively. Indications were venous (48%), arterial (31%), unknown (10%), and hematoma (10%). Overall outcomes were complete salvage (37%), partial failure (25%), and total failure (38%). Takebacks occurring within 48 hours postoperatively correlated with higher salvage rates (p=0.022). Fasciocutaneous flaps demonstrated increased takeback rates compared with muscle flaps (p=0.005) which more frequently occurred within 48 hours postoperatively (RR=13.2, p=0.012). Fasciocutaneous flaps were successfully salvaged more often than muscle-based flaps (p