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

The retrospective review analyzed 14 free flaps in 12 patients for skull coverage from 1982 to 2003, comparing muscle-only and composite free flaps. It was found that muscle-only free flaps were more prone to serious long-term complications like implant extrusion and chronic ulcerations, likely due to flap thinness from muscle atrophy or initial inadequate thickness. With a mean follow-up of 43.0 months for muscle-only flaps and 23.7 months for composite flaps, the study concluded that for a permanent, trouble-free outcome, initial selection should favor composite flaps or sufficiently thick muscle flaps, indicating the potential long-term superiority of composite flaps for skull coverage.