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J Reconstr Microsurg 2023; 39(07): 526-539
DOI: 10.1055/a-2003-8789
Original Article

Outcomes of Free Muscle Flaps versus Free Fasciocutaneous Flaps for Lower Limb Reconstruction following Trauma: A Systematic Review and Meta-Analysis

Todd Dow 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
,
Rawan ElAbd
2   Division of Plastic & Reconstructive Surgery, McGill University, Montreal, Canada
3   Division of Plastic & Reconstructive Surgery, Jaber Al Ahmed Al Jaber Al Sabah Hospital, Surra, Kuwait
,
Connor McGuire
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
,
Joseph Corkum
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
,
Sarah Al Youha
3   Division of Plastic & Reconstructive Surgery, Jaber Al Ahmed Al Jaber Al Sabah Hospital, Surra, Kuwait
,
Osama Samargandi 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
4   Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
,
Jason Williams
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
› Author Affiliations Funding None.
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Abstract

Background Free flap reconstruction of the lower limb following trauma often suffers higher complication rates than other areas of the body. The choice of muscle or fasciocutaneous free flap is an area of active debate.

Methods A systematic review of EMBASE, MEDLINE, PubMed, and Cochrane Register from inception to April 1, 2022 was performed. Articles were assessed using the methodological index for non-randomized studies instrument. The primary outcome was to assess and compare the major surgical outcomes of partial or total flap failure, reoperation, and amputation rates.

Results Seventeen studies were included. All studies were retrospective in nature, of level three evidence, and published between 1986 and 2021. The most common muscle and fasciocutaneous free flaps used were latissimus dorsi flap (38.1%) and anterolateral thigh (ALT) flap (64.8%), respectively. Meta-analysis found no significance difference in rates of total flap failure, takeback operations, or limb salvage, whereas partial flap failure rate was significantly lower for fasciocutaneous flaps. The majority of studies found no significant difference in complication rates, osteomyelitis, time to fracture union, or time to functional recovery. Most, 82.4% (14/17), of the included studies were of high methodological quality.

Conclusion The rate of total flap failure, reoperation, or limb salvage is not significantly different between muscle and fasciocutaneous free flaps after lower limb reconstruction following trauma. Partial flap failure rates appear to be lower with fasciocutaneous free flaps. Outcomes traditionally thought to be managed better with muscle free flaps, such as osteomyelitis and rates of fracture union, were comparable.

Keywords

free muscle flap - free fasciocutaneous flap - surgical outcomes - lower limb - trauma

Note

This article conforms to the guidelines set forth by the Helsinki Declaration in 1975. This article also conforms to the PRISMA guidelines.


Authors' Contributions

T.D.: Contributed to study design, data acquisition, data extraction, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


R.E.A.: Contributed to data acquisition, data extraction, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


C.M.: Contributed to data acquisition, data extraction, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


J.C.: Contributed to study design, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


S.A.Y.: Contributed to study design, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


O.S.: Contributed to study design, data acquisition, data extraction, analysis of results, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.


J.W.: Contributed to study design, drafting of the manuscript, final approval of the manuscript, and agrees to be held accountable for all aspects of the work.




Publication History

Received: 16 April 2022

Accepted: 30 November 2022

Accepted Manuscript online:
28 December 2022

Article published online:
27 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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