Long-Term Superiority of Composite Versus Muscle-Only Free Flaps for Skull Coverage

In Brief Long-term follow-up of free flaps used for skull coverage in this experience has revealed that serious sequela are more likely after muscle-only free flaps. Over the past 2 decades, 8 muscle and 6 composite free flaps have been used in 12 patients. Debulking was the only secondary procedure necessary in 1 composite flap. However, implant extrusion through 1 muscle flap and chronic ulcerations after minor trauma in 2 other muscle flaps could be directly attributed to the thinness of these flaps. Whether these problems were a consequence of inevitable muscle atrophy or improper selection of too thin a muscle flap from the outset is unknown. Thus, it must be suggested that either a composite flap or a known thick muscle should be chosen initially if a permanent trouble-free outcome is to be expected. A long-term follow-up review of 14 muscle and free flap scalp reconstructions in 12 patients disclosed that thin muscle flaps were at greater risk for subsequent breakdown than were composite flaps incorporating muscle or fascia with overlying skin.