Donor-Site Morbidity Following Free Tissue Harvest from the Thigh: A Systematic Review and Pooled Analysis of Complications

Abstract

Background Donor-site morbidity significantly influences patient satisfaction and quality of life following reconstructive surgery. The relevant donor-site morbidities associated with more commonly utilized thigh-based flaps are reviewed. Methods A systematic search of the MEDLINE and Cochrane databases from 1994 to 2014 was conducted to identify all reports of "anterolateral thigh (ALT)," "vastus lateralis (VL)," "anteromedial thigh (AMT)," "transverse upper gracilis (TUG)," tensor fascia latae (TFL)," "gracilis," and "rectus femoris (RF)," flaps. Only studies that investigated donor-site outcomes related to pain, paresthesia, wound dehiscence, infection, hematoma, seroma, contour deformity, and/or objective functional performance were included. Case series or anecdotal reports with less than five flaps, non-English, and animal studies were excluded. Results A total of 116 articles representing 4,554 flaps were reviewed, including 2,922 ALT/VL, 148 AMT, 436 TUG, 278 TFL, 527 gracilis, and 243 RF flaps. The most frequently cited donor-site complication was paresthesia (range: 0-36.4%), followed by wound dehiscence (range: 0.9-8.3%), contour deformity (range: 0-5.2%), pain (range: 0-6.3%), and seroma (range: 0.4-2.0%). Despite mixed results regarding functional performance, pooled-analysis of dynamometric studies demonstrated a significant reduction in strength only after RF flap harvest (21%). Conclusions Donor-site morbidity for thigh-flaps is minimal and appears to be well-tolerated by the majority of patients. Nevertheless, the appropriate flap selection is highly individualized, and patients must be informed of potential complications and morbidities specific to each flap. We have established the most current review of donor-site morbidity for thigh-based flaps to aid the surgeon in this important discussion.

Haemodynamically stimulated and in vivo generated axially vascularized soft‐tissue free flaps for closure of complex defects: Evaluation in a small animal model

“…The transferred tissue has to provide a sufficient blood perfusion in order to avoid infections or unstable scar formation, and to facilitate wound healing as well as a good functional outcome (Hirche et al, ; Xiong et al, ). In clinical practice, vascularized flaps meet these requirements but are burdened with size limitations and donor site morbidity (Lakhiani, DeFazio, Han, Falola, & Evans, ; Lee & Mun, ; Paro, Chiou, & Sen, ; Seidenstuecker et al, ). Moreover, in the case of large burn injuries or extensive trauma, donor sites for free flaps are scarce in general.…”

The Arteriovenous Loop: Engineering of Axially Vascularized Tissue

“…Depending on the site and size of the defects, as well as on properties of the flap, such as tissue composition and vascular supply [6], there are various autologous grafts that are currently used for transplantation, e.g., parts of the fibula, scapula, or the gastrocnemius muscle. However, the harvesting procedure creates an additional surgical site and can be associated with donor site morbidities such as loss or impairment of function, infection, swelling, contour deformities, and pain [7]. A further drawback of autologous transplants is the fixed shape of the grafts.…”

Postoperative mechanical bowel obstruction after pharyngolaryngectomy for hypopharyngeal cancer: Retrospective analysis using a Japanese inpatient database

“…In western countries, the ALT flap is most commonly used because harvesting of the tissue is a relatively simple procedure and the vascular anatomy is predictable. A recent systematic review demonstrated that an ALT flap is well‐tolerated by the majority of patients, even after taking into account some minor complications …”

“…A recent systematic review demonstrated that an ALT flap is well-tolerated by the majority of patients, even after taking into account some minor complications. 4 Postoperative mechanical bowel obstruction caused by impaired intestinal motility is a rare but potentially unavoidable complication after any type of abdominal surgery, 5 including in the setting of an additional abdominal procedure to harvest a free jejunum graft or to pull up the stomach for defected site after pharyngolaryngectomy. Such donor-site complications can result in prolonged hospitalization and excessive healthcare utilization, and, thus, increased medical and economic burdens on the patient.…”