Free flaps for reconstruction of soft tissue defects in lower extremity: A meta‐analysis on microsurgical outcome and safety

Xiong, Lingyun; Gazyakan, Emre; Kremer, Thomas; Hernekamp, Frederick; Harhaus, Leila; Saint‐Cyr, Michel; Kneser, Ulrich; Hirche, Christoph

doi:10.1002/micr.30020

Cited by 138 publications

(134 citation statements)

References 55 publications

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“…This analysis revealed that the gracilis flap was the 3 rd most utilized flap after the anterolateral thigh flap and latissimus dorsi flap 14 . Our failure rate is consistent with this and other published reports 12,14,18 . In a retrospective review of 119 free flaps in 114 patients, Fischer et al reported using the gracilis free flap in only 3 (2.5%) cases.…”

Section: Discussionmentioning

confidence: 98%

“…As surgeons became comfortable harvesting the ALT, this flap was found to be reliable and effective in covering open fractures in the lower extremity 9–11 . While the introduction of locoregional propeller and perforator flaps over the last decade has expanded reconstructive options in the lower extremity, free tissue transfer with the ALT flap has remained the predominant technique for coverage of complex lower extremity defects as it avoids the zone of injury, which often limits the utilization of locoregional flap coverage 12–14 . However, despite its popularity, the ALT flap is not without limitations in the coverage of lower extremity defects.…”

Section: Introductionmentioning

confidence: 99%

“…While the gracilis muscle flap has been well described from an anatomic standpoint, the utility of this flap in lower extremity reconstruction is underreported in the literature as it is often considered a secondary or tertiary option 12,14,19,20 . Furthermore, there is a paucity of data on long-term outcomes and revision rates following free gracilis muscle flap reconstruction of lower extremity defects, with reports including pediatric patients specifically lacking in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Lower Extremity Reconstruction with Free Gracilis Flaps

Franco

Nicoson

Parikh

et al. 2016

J reconstr Microsurg

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Background There have been significant advancements in lower extremity reconstruction over the last several decades, and the plastic surgeon’s armamentarium has grown to include free muscle and fasciocutaneous flaps along with local perforator and propeller flaps. While we have found a use for a variety of techniques for lower extremity reconstruction, the free gracilis has been our workhorse flap due to the ease of harvest, reliability, and low donor site morbidity. Methods This is a retrospective review of a single surgeon’s series of free gracilis flaps utilized for lower extremity reconstruction. Demographic information, comorbidities, outcomes and secondary procedures were analyzed. Results We identified 24 free gracilis flaps. The duration from injury to free flap coverage was 7 days or less in 6 patients, 8–30 days in 11 patients, 31–90 days in 4 patients, and > 90 days in 3 patients. There were 22 (92%) successful flaps and an overall limb salvage rate of 92%. There was one partial flap loss. Two flaps underwent incision and drainage in the operating room for infection. Two patients developed donor site hematomas. Four patients underwent secondary procedures for contouring. Our subset of pediatric patients had 100% flap survival and no secondary procedures at a mean 30 month follow up. Conclusions This study demonstrates the utility of the free gracilis flap in reconstruction of small to medium sized defects of the lower extremity. This flap has a high success rate and low donor site morbidity. Atrophy of the denervated muscle over time allows for good shoe fit, often obviating the need for secondary contouring procedures.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Lower Extremity Reconstruction with Free Gracilis Flaps

Franco

Nicoson

Parikh

et al. 2016

J reconstr Microsurg

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“…Gir et al believe that pedicled perforator flap use is a safe and reliable procedure for reconstructing soft tissue defects [29]. Xiong et al [30] and Kang et al [31] think that free flap use in foot and ankle reconstruction is safe and reliable due to very robust vascularization and a low risk of infection. However, in our study, Fig 3 and Table 4 indicate that flap type significantly affects the perioperative flap survival rate in the foot and ankle.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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ObjectiveThe purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle.MethodsThis was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model.ResultsThe overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection.ConclusionFlap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.

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“…Lesions of the endothelial tissue of the vessel and stasis of blood flow are the main factors for thrombosis that may occur during surgery. [7] …”

Section: Introductionmentioning

confidence: 99%

Early risk prognosis of free-flap transplant failure by quantitation of the macrophage colony-stimulating factor in patient plasma using 2-dimensional liquid-chromatography multiple reaction monitoring-mass spectrometry

et al. 2016

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Free flaps for reconstruction of soft tissue defects in lower extremity: A meta‐analysis on microsurgical outcome and safety

Abstract: Microsurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. © 2016 Wiley Periodicals, Inc. Microsurgery 36:511-524, 2016.

Cited by 138 publications

References 55 publications

Lower Extremity Reconstruction with Free Gracilis Flaps

Lower Extremity Reconstruction with Free Gracilis Flaps

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Early risk prognosis of free-flap transplant failure by quantitation of the macrophage colony-stimulating factor in patient plasma using 2-dimensional liquid-chromatography multiple reaction monitoring-mass spectrometry

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