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Does Flap Reconstruction Choice Contribute to Heterotopic Ossification Development in Traumatic Complex Periarticular Injuries?
Jennifer Sabino, MD, Benjamin Wheatley, MD, Victor W. Wong, MD, Scott Tintle, MD, Mark Fleming, DO, Benjamin K. Potter, MD, Barry Martin, MD, Ian Valerio, MD.
Walter Reed National Military Medical Center, Rockville, MD, USA.

Introduction: Heterotopic ossification (HO) is a debilitating complication of trauma. Functional limitations are especially critical when HO involves the joints. Our group has noted an increased rate of HO formation in trauma requiring flap coverage. The purpose of this study was to determine if fasciocutaneous versus myocutaneous flaps for periarticular coverage had any effect on HO formation.
Methods: A retrospective review of traumatic extremity reconstructions requiring flap coverage from 2003-2014 at Walter Reed National Military Medical Center was performed. Data collected included type of flap, joint involvement, HO formation, and complications.
Results: A total of 389 tissue transfers for traumatic extremity injuries were performed. Sixty-nine cases (18%) involved a major joint injury, with 32 fasciocutaneous and 37 muscle flaps providing joint coverage. The presence of HO at any location was 84.4% and 86.5% in the fasciocutaneous and muscle groups, respectively (p>0.05). HO involving the underlying joint was present in 46.9% in the fasciocutaneous group and 48.7% in the muscle group (p>0.05). The mean time to radiographic identification of HO was 184 and 221 days in the fasciocutaneous and muscle groups, respectively (p<0.05).
Conclusion: War trauma is associated with high rates of HO formation, 64% in previous studies. Our study shows an HO rate greater than 85% for casualties requiring flap coverage. Our group found no difference in the prevalence of HO associated with type of flap. A faster rate of formation was noted in the fasciocutaneous group compared to the muscle group.


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