Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness.

BACKGROUND: Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity. METHODS: Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients. RESULTS: There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group. CONCLUSIONS: Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.

Anatomy and vascularization of the flexor hallucis longus muscle and its implication in free fibula flap transfer: an anatomical study.

Contracture as well as weakness of the flexor hallucis longus (FHL) are possible complications following free fibula flap harvest. Possible causes have been related to fibrotic change of the muscle either due to devascularization or compartment-like syndrome after a tight wound closure. This study elucidates the vascularization and nerve supply of the FHL muscle after fibula flap harvest in a fresh cadaver model.A fibula bone flap was harvested through a lateral approach in 20 fresh limbs. The popliteal artery was isolated and injected with a silicone compound, the muscle isolated, and its neurovascular supply visualized.The distal third and fourth portion of the FHL muscle was always found to be located in a more compressed and deeper compartment. The peroneal artery was entirely filled by the silicone compound in 17 fresh cadaver limbs with at least one branch supplying the distal fourth of the FHL. The posterior tibialis artery was filled in all limbs and an average of 2 branches was found to supply the muscle. In all dissections, the nerve supplying the FHL originated from the tibialis nerve with an average of three branches perforating the muscle.Following fibula harvest, the FHL muscle will maintain vascular supply through the distal portion of the peroneal artery and the posterior tibialis artery. Nerve injury to the FHL muscle is unlikely during flap harvest.