A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy

Abdelrahman, Islam; Moghazy, Amr; Abbas, Ashraf; Elmasry, Moustafa; Adly, Osama A.; Elbadawy, Mohamed A.; Steinvall, Ingrid; Sjöberg, Folke

doi:10.1016/j.bjps.2016.04.013

Cited by 16 publications

(14 citation statements)

References 16 publications

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“…Defect aetiology varied greatly between and inside the selected studies including traumatism, neoplasm, infections, scar contractures, and chronic wounds (with peripheral vascular disease, irradiation, and neuropathy). Complete flap necrosis was reported in all 10 articles and the pooled analysis did not find a significant difference between FF and PF (RR 1.35, 95%CI 0.76-2.39, p = 0.31) [12][13][14][15][16][17][18][19][20][21]. (Figure 2) A partial flap failure was reported in eight articles and FF had a significantly lower risk than PF in the pooled analysis (RR 0.45, 95%CI 0.22-0.91, p = 0.03) [12][13][14][15][16][18][19][20] (Figure 3).…”

Section: Resultsmentioning

confidence: 82%

“…Complete flap necrosis was reported in all 10 articles and the pooled analysis did not find a significant difference between FF and PF (RR 1.35, 95%CI 0.76-2.39, p = 0.31) [12][13][14][15][16][17][18][19][20][21]. (Figure 2) A partial flap failure was reported in eight articles and FF had a significantly lower risk than PF in the pooled analysis (RR 0.45, 95%CI 0.22-0.91, p = 0.03) [12][13][14][15][16][18][19][20] (Figure 3). Overall complication rates were reported in six studies, and the pooled analysis found no significant difference between FF and PF concerning the overall risk of complications (RR 0.83, 95%CI 0.64-1.07, p = 0.16) [13,15,16,[19][20][21] (Figure 4).…”

Section: Resultsmentioning

confidence: 82%

“…After being screened by title and abstract, only 19 studies were considered eligible for complete reading. Ten studies met all the selection criteria [12][13][14][15][16][17][18][19][20][21] (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

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Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Scampa

Mégevand

Suvà

et al. 2022

JCM

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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, p = 0.31), the partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22–0.91, p = 0.03). The overall complication rate (RR 0.83, 95%CI 0.64–1.07, p = 0.16) and revision surgery rate (RR 1.38, 95%CI 0.55–3.50, p = 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, p = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55–1.33, p = 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.

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Section: Resultsmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 82%

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Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Scampa

Mégevand

Suvà

et al. 2022

JCM

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“…1 However, a high level of training, expertise, and experience is needed apart from higher costs than with local or pedicled flaps. 14 Local solutions such as reversed flow island flaps, perforator flaps, keystone flaps, and local muscle or skin flaps are available options and in many hands easier to perform. 1,15 A total assessment of the patient’s need of coverage in relation to local factors as well as age and comorbidities is crucial.…”

Section: Discussionmentioning

confidence: 99%

Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction

Abdelrahman

Elmasry

Steinvall

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…Free-flaps is the best method for coverage of soft tissue defects in this area but the procedure is technically difficult, requires skilled surgeons and the recipient site should have suitable vessels which is a big problem in major tibial fractures[16-18]. Perforator-based flaps or a distally-based soleus flap may be suitable for the lower third of the leg but the results are controversial[19-21].…”

Section: Discussionmentioning

confidence: 99%

Unhappy triad in limb reconstruction: Management by Ilizarov method

El-Alfy

2017

WJO

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AIMTo evaluate the results of the Ilizarov method in management of cases with bone loss, soft tissue loss and infection.METHODSTwenty eight patients with severe leg trauma complicated by bone loss, soft tissue loss and infection were managed by distraction osteogenesis in our institution. After radical debridement of all the infected and dead tissues the Ilizarov frame was applied, corticotomy was done and bone transport started. The wounds were left open to drain. Partial limb shortening was done in seven cases to reduce the size of both the skeletal and soft tissue defects. The average follow up period was 39 mo (range 27-56 mo).RESULTSThe infection was eradicated in all cases. All the soft tissue defects healed during bone transport and plastic surgery was only required in 2 cases. Skeletal defects were treated in all cases. All patients required another surgery at the docking site to fashion the soft tissue and to cover the bone ends. The external fixation time ranged from 9 to 17 mo with an average of 13 mo. The complications included pin tract infection in 16 cases, wire breakage in 2 cases, unstable scar in 4 cases and chronic edema in 3 cases. According to the association for study and application of methods of Ilizarov score the bone results were excellent in 10, good in 16 and fair in 2 cases while the functional results were excellent in 8, good in 17 and fair in 3 cases.CONCLUSIONDistraction osteogenesis is a good method that can treat the three problems of this triad simultaneously.

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A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy

Cited by 16 publications

References 16 publications

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction

Unhappy triad in limb reconstruction: Management by Ilizarov method

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