Artikel
The reconstruction of lower extremity soft tissue defects using free flaps – a meta-analysis on recipient-site complications
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Autoren
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Lingyun Xiong
- BG Klinik Ludwigshafen, Hand,-Plastische und Rekonstruktive Chirurgie, Ludwigshafen, Deutschland; Union Universitätsklinikum, Universität Huazhong für Wissenschaft und Technologie, Abteilung für Plastische und Rekonstruktive Chirurgie, Wuhan, China
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Christoph Hirche
- Ludwigshafen, Deutschland
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Emre Gazyakan
- Ludwigshafen, Deutschland
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Thomas Kremer
- Ludwigshafen, Deutschland
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Andreas Nüssler
- Tübingen, Deutschland
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Ulrich Kneser
- Ludwigshafen, Deutschland
| Veröffentlicht: | 3. September 2014 |
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Gliederung
Text
Background: Free flap transplantation for soft tissue reconstruction in lower extremity has greatly evolved in past decades. However, it is still challenging due to recipient-site complications. Previously, various recipient-site complication rates have been continually reported with relatively low level of evidences and potential biases. A Meta – analysis of the literature published from 2000 to 2014 in English, Chinese and German was conducted to provide preliminary estimation on its true clinical performances and provide evidences for future clinical practices.
Methods: Eligible studies were identified from systematical PubMed and EMBASE searches; data were extracted. A Meta – analysis was performed to generate pooled recipient-site complication rate in aspects of flap loss, hematoma, thrombosis, partial necrosis, early infection and dehiscence. Subgroup analyses were then preformed and publication biases were assessed.
Results: Forty-four publications were included. Clinical data of 1152 patients and 1180 flaps were obtained. The pooled complication rates of flap loss, hematoma, thrombosis, partial necrosis, early infection and dehiscence as well as their 95% confidence intervals were 0.02 (0.01 – 0.04), 0.00 (0.00 – 0.01), 0.02 (0.01 – 0.06), 0.04 (0.02 – 0.06), 0.00 (0.00 – 0.01) and 0.01 (0.00 – 0.02), respectively. Relatively higher complication rates have been found in the subgroup analysis of diabetic foot reconstruction basing on 367 flaps. The pooled complication rates of flap loss, hematoma, thrombosis, partial necrosis, early infection and dehiscence as well as their 95% confidence intervals were 0.04(0.01, 0.07), 0.00(0.00, 0.00), 0.04(0.00, 0.11), 0.06(0.03, 0.10), 0.00(0.00, 0.01) and 0.04(0.01, 0.07), respectively. Significant heterogeneities existed among studies. Significant publication bias was found among infection rates.
Conclusion: This technique could be valued reliable for the soft tissue reconstruction in lower extremity. Patients with diabetic foot may suffer more recipient-site complications. More well designed studies are needed to provide more evidences in the future.
