Microsurgical soft tissue reconstruction in lower extremity osteitis

Abstract

The aim of this study was to analyse retrospectively the pre- and intraoperative factors influencing flap loss after free flap coverage of septic skin defects caused by osteitis of the lower extremity with an anterolateral thigh flap (ALT) or latissimus dorsi (LD) flap. Twenty-seven patients were surgically treated with LD flap coverage and 45 patients with ALT flap coverage between 2004 and 2013. Their anthropometric, pre- and intraoperative parameters were investigated retrospectively. Flap survival was 81.5 % for LD flaps and 82.2 % for ALT flaps. Major complications led to a significantly higher flap loss both in LD (p = 0.01) and ALT flaps (p < 0.0001). Furthermore, there was a significant increase in flap loss with pre-existing diabetes mellitus in the LD group (p = 0.001) and with acute osteomyelitis being the underlying cause of the soft tissue defect in the ALT group (p = 0.034). Regardless of the flap's postoperative success, LD flaps were used for significantly larger soft tissue defects to be reconstructed (p = 0.001), with the duration of surgery (p < 0.0001) and cold ischaemia time (p = 0.001) being significantly longer compared with ALT flaps. The success of microsurgical flap reconstruction in lower extremities after osteitis was influenced by a low number of cases with preexisting diabetes mellitus, causative acute osteomyelitis, and major complications. Therefore, optimal management of both parameters and precise microsurgical anastomosis are prerequisites for successful plastic reconstruction of soft tissue defects.