Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies
Background: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes. Method: A systematic revi...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/13/3672 |
| _version_ | 1797434195448954880 |
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| author | Matteo Scampa Vladimir Mégevand Domizio Suva Daniel F. Kalbermatten Carlo M. Oranges |
| author_facet | Matteo Scampa Vladimir Mégevand Domizio Suva Daniel F. Kalbermatten Carlo M. Oranges |
| author_sort | Matteo Scampa |
| collection | DOAJ |
| description | Background: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes. Method: A systematic review of pubmed, EMBASE, Cochrane library, and Web of Science was conducted, aiming at articles comparing the outcomes of free versus pedicled flaps in lower limb reconstruction. A pooled analysis with the Mantel and Haenszel methods and random effect analysis provided results as a risk ratio with a 95% confidence interval. Results: 10 retrospective studies were selected. While the flap necrosis rate did not differ significantly between techniques (RR 1.35, 95%CI 0.76–2.39, <i>p</i> = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22–0.91, <i>p</i> = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64–1.07, <i>p</i> = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55–3.50, <i>p</i> = 0.49) did not differ significantly. No significant difference was found in the high aesthetic satisfaction rate (RR 1.76, 95%CI 0.57–5.41, <i>p</i> = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55–1.33, <i>p</i> = 0.48). Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies for lower limb reconstruction with similar surgical outcomes. |
| first_indexed | 2024-03-09T10:27:46Z |
| format | Article |
| id | doaj.art-feff26c91b984793a24b6d45769139d3 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T10:27:46Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-feff26c91b984793a24b6d45769139d32023-12-01T21:32:28ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011113367210.3390/jcm11133672Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative StudiesMatteo Scampa0Vladimir Mégevand1Domizio Suva2Daniel F. Kalbermatten3Carlo M. Oranges4Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, SwitzerlandDepartment of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, SwitzerlandBone Infection Unit, Department of Orthopedic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, SwitzerlandDepartment of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, SwitzerlandDepartment of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, Geneva University, 1205 Geneva, SwitzerlandBackground: Free and pedicled flaps are both valuable surgical strategies for lower limb reconstruction. Evidence that compares both techniques is scarce. Our aim is to synthetise all the comparative studies by conducting a meta-analysis to identify post-operative outcomes. Method: A systematic review of pubmed, EMBASE, Cochrane library, and Web of Science was conducted, aiming at articles comparing the outcomes of free versus pedicled flaps in lower limb reconstruction. A pooled analysis with the Mantel and Haenszel methods and random effect analysis provided results as a risk ratio with a 95% confidence interval. Results: 10 retrospective studies were selected. While the flap necrosis rate did not differ significantly between techniques (RR 1.35, 95%CI 0.76–2.39, <i>p</i> = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22–0.91, <i>p</i> = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64–1.07, <i>p</i> = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55–3.50, <i>p</i> = 0.49) did not differ significantly. No significant difference was found in the high aesthetic satisfaction rate (RR 1.76, 95%CI 0.57–5.41, <i>p</i> = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55–1.33, <i>p</i> = 0.48). Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies for lower limb reconstruction with similar surgical outcomes.https://www.mdpi.com/2077-0383/11/13/3672free flappedicled flapmeta-analysisoutcomescomparativelower limb |
| spellingShingle | Matteo Scampa Vladimir Mégevand Domizio Suva Daniel F. Kalbermatten Carlo M. Oranges Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies Journal of Clinical Medicine free flap pedicled flap meta-analysis outcomes comparative lower limb |
| title | Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies |
| title_full | Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies |
| title_fullStr | Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies |
| title_full_unstemmed | Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies |
| title_short | Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies |
| title_sort | free versus pedicled flaps for lower limb reconstruction a meta analysis of comparative studies |
| topic | free flap pedicled flap meta-analysis outcomes comparative lower limb |
| url | https://www.mdpi.com/2077-0383/11/13/3672 |
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