Dataset Information

Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis.

ABSTRACT:

Background

Free flap reconstruction in acute burns is high risk but often required for limb salvage and coverage of vital structures. Prior studies have shown a flap loss rate up to 44%. This study aimed to compare the complications associated with muscle and fasciocutaneous free flaps in acute burn reconstruction.

Methods

A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered on the PROSPERO database (CDR42023471088). The databases accessed were Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was free flap failure rate based on flap type. Secondary outcomes included venous congestion, arterial thrombosis, amputation, and need for reintervention.

Results

Twelve studies with 181 free flaps were included: 87 muscle flaps and 94 fasciocutaneous flaps. Muscle flaps had a higher risk ratio (RR) for total flap loss [RR: 2.32, 95% confidence interval (CI): 1.01-5.32, P = 0.04], arterial thrombosis (RR: 3.13, 95% CI: 1.17-8.42, P = 0.02), and amputations (RR: 8.89, 95% CI: 1.27-70.13, P = 0.03) compared with fasciocutaneous flaps. No significant differences were found in venous thrombosis (RR: 1.33, 95% CI: 0.37-4.78, P = 0.65) or need for reinterventions (RR: 1.34, 95% CI: 0.77-2.32, P = 0.29).

Conclusions

Muscle flaps in burn injuries are associated with higher risks of flap failure, arterial thrombosis, and amputations. Fasciocutaneous free flaps in acute burns seem to be safer with better outcomes, though further research is needed to confirm these findings.

SUBMITTER: Arellano JA

PROVIDER: S-EPMC11315554 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis.

Arellano José Antonio JA Alessandri-Bonetti Mario M Liu Hilary Y HY Pandya Sumaarg S Egro Francesco M FM

Plastic and reconstructive surgery. Global open 20240809 8

<h4>Background</h4>Free flap reconstruction in acute burns is high risk but often required for limb salvage and coverage of vital structures. Prior studies have shown a flap loss rate up to 44%. This study aimed to compare the complications associated with muscle and fasciocutaneous free flaps in acute burn reconstruction.<h4>Methods</h4>A systematic review and meta-analysis was conducted according to PRISMA guidelines and registered on the PROSPERO database (CDR42023471088). The databases acces ...[more]

PMID: 39129843

Similar Datasets

Project description:Background Choosing the components of free flap (fasciocutaneous or muscle) is one of the crucial but controversial decisions in heel reconstruction. This meta-analysis aims to provide an up-to-date comparison of fasciocutaneous flaps (FCFs) and muscle flaps (MFs) for heel reconstruction and to ascertain if one flap has an advantage over the other. Methods Following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed identifying studies on heel reconstruction with FCF and MF. Primary outcomes were survival, time of ambulation, sensation, ulceration, gait, need for specialized footwear, revision procedures, and shear. Meta-analyses and Trial Sequential Analysis (TSA) were performed to estimate the pooled risk ratios (RRs) and standardized mean difference (SMD) with fixed effects and random effects models, respectively. Results Of 757 publications identified, 20 were reviewed including 255 patients with 263 free flaps. The meta-analysis showed no statistically significant difference between MF and FCF in terms of survival (RR, 1; 95% confidence interval [CI], 0.83, 1.21), gait abnormality (RR, 0.55; 95% CI, 0.19, 1.59), ulcerations (RR, 0.65; 95% CI, 0.27, 1.54), footwear modification (RR, 0.52; 95% CI, 0.26, 1.09), and revision procedures (RR, 1.67; 95% CI, 0.84, 3.32). FCF had superior perception of deep pressure (RR, 1.99; 95% CI, 1.32, 3.00), light touch, and pain (RR, 5.17; 95% CI, 2.02, 13.22) compared with MF. Time to full weight-bearing (SMD, -3.03; 95% CI, -4.25, -1.80) was longer for MF compared with FCF. TSA showed inconclusive results for comparison of the survival of flaps, gait assessment, and rates of ulceration. Conclusion Patients reconstructed with FCF had superior sensory recovery and early weight bearing on their reconstructed heels, hence faster return to daily activities compared with MFs. In terms of other outcomes such as footwear modification and revision procedure, both flaps had no statistically significant difference. The results were inconclusive regarding the survival of flaps, gait assessment, and rates of ulceration. Future studies are required to investigate the role of shear on the stability of the reconstructed heels.

Project description:IntroductionPartial tongue reconstruction requires a thin pliable flap to restore volume and mobility. The lateral arm flap is well suited to this as it is a thin fasciocutaneous flap that has consistent vascular anatomy, reliable perfusion, short harvest time and low donor site morbidity. The authors report our experience with use of this flap for reconstruction of hemi-glossectomy defects.MethodsThis is a retrospective cohort of patients who underwent reconstruction of hemi-glossectomy and floor of mouth defects with a lateral arm flap, at Aga Khan University Hospital, Karachi (Pakistan) from November 2016 to January 2020. Flaps were harvested from the nondominant upper extremity. Data were collected for patient demographics, size of defect, size of flap, recipient vessels, postoperative complications and functional outcome.ResultsOver a 3-year period, 8 hemi-tongue and extended hemi-tongue, and floor of mouth reconstructions were performed with a lateral arm fasciocutaneous flap. A standard lateral arm flap was harvested in 3 patients and an extended lateral arm flap in 5 patients. Mean flap size was 65.75 cm2 (48-76 cm2). The recipient artery in all cases was the superior thyroid artery. The recipient veins were the common facial vein in 1 patient, the internal jugular in 3 patients, the external jugular in 1 patient and both external and internal jugular in 3 patients. Donor sites were closed primarily. There were no total or partial flap losses. All patients were able to resume an oral diet (unrestricted in 1, soft in 4, pureed in 2 patients). Postoperative speech was intelligible to patients' family in 4 patients and to strangers in 3 patients. One patient succumbed to progressive disease in the early postoperative period. Orocutaneous fistulas developed in 3 patients, all of which healed with nonoperative management.ConclusionsThe lateral arm fasciocutaneous flap is well suited for reconstruction of hemiglossectomy and floor of mouth defect. It has the advantages of straightforward harvest, thin and pliable soft tissue, and low donor site morbidity.

Dataset Information

Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis.

Background

Methods

Results

Conclusions

Publications

Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burns: A Systematic Review and Meta-analysis.

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