The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis

Escandón, Joseph M.; Bustos, Valeria P.; Escandón, Lauren; Santamaría, Eric; Gaxiola-García, Miguel Ángel; Kushida-Contreras, Beatriz Hatsue; Forte, Antonio J.; Ciudad, Pedro; Langstein, Howard N.; Manrique, Oscar J.

doi:10.1055/s-0041-1733978

Cited by 10 publications

(5 citation statements)

References 72 publications

(133 reference statements)

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“…However, Wilkman et al (2019) identified the highest rate of flap loss (14%) among the deep circumflex iliac artery (DCIA) flap compared with the SFF (0%) and FFF (3%). A meta‐analysis on the versatility of the DCIA free flap reported a pooled flap failure rate of 4% (Escandón et al, 2022). Overall, our findings of a 2% flap failure rate suggest that the SFF is a reliable option with flap failure rates comparable with the current gold standard flaps and possibly superior to the DCIA flap.…”

Section: Discussionmentioning

confidence: 99%

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Escobar‐Domingo,

Bustos,

Akintayo

et al. 2024

Microsurgery

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BackgroundThe scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.MethodsA comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.ResultsA total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%–4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.ConclusionThe SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions—both for vascularized bone and cutaneous skin—augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.

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Section: Discussionmentioning

confidence: 99%

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Escobar‐Domingo,

Bustos,

Akintayo

et al. 2024

Microsurgery

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“…6 Because of the morphology and function of the head and neck, important structures such as main vessels and the central nervous system require expeditious coverage 20 ; and adjuvant radiotherapy and chemotherapy, saliva, and infection can severely affect the wound bed for tissue transfer. 6,21 Moreover, the nutritional status of patients and multiple comorbidities can also compromise the recipient site, 6 ultimately affecting the normal progression of wound healing. In our study, pedicle flaps (91%) were shown to be reliable for a successful secondary reconstruction compared with free flaps (71.4%).…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure

Gupta

Goil

Mohammad

et al. 2023

Plastic &Amp; Reconstructive Surgery

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ree tissue transfer is considered the standard treatment for oncologic reconstruction of head and neck defects, as it has been shown to offer equivalent success rates of flap survival in comparison to regional flaps, with the advantage of optimizing function. [1][2][3][4] The overall rate of a successful free flap for head and neck reconstruction in large centers has been reported to be approximately 95%. 5 Nonetheless, outcomes are generally suboptimal if flaps present vascular complications requiring reexploration after primary Background: Finite options exist to address free flap failure. There is a lack of consensus on the standard treatment for secondary reconstruction in such cases. Herein, the authors determined the survival rate of a second flap following a total loss of an initial free flap during head and neck reconstructions and evaluated whether there was a difference in the rate of secondary flap necrosis depending on the timing of reconstruction salvage. Methods: The authors retrospectively reviewed 1572 free flaps for head and neck reconstruction from 2010 to 2022. Patients who underwent secondary surgery with flaps after failure of a primary free flap were included. Patients were divided into three groups based on the time for secondary flap reconstruction from the time of primary reconstruction (group A, 0 to 5 days; group B, 6 to 30 days; and group C, >30 days). Results: The authors identified 64 cases of complete flap loss after primary reconstruction requiring secondary reconstruction. Pedicled flaps were used in 34.4% of the cases, whereas a second free flap was used in 65.6% of the cases. Overall, the flap failure rate for secondary reconstructions was 6.7% in group A, 35.3% in group B, and 6.7% in group C (P = 0.022). For free tissue transfer, the success rate of a secondary reconstruction was 92.3% in group A, 28.57% in group B, and 93.3% in group C. Conclusions: The authors favor an early microsurgical reconstruction (≤5 days) following primary reconstruction in cases of free flap failure. If early reconstruction cannot be performed, a deferred reconstruction with free tissue transfer (>30 days) should be considered.

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“…Subsequently, the graft became well-known and widely used. 13 In 1990, Solonen et al 14 reported using a DCIA-vascularized iliac graft to treat ONFH. This article is protected by copyright.…”

Section: Introductionmentioning

confidence: 99%

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study

He,

Lu,

Chen

et al. 2024

J Reconstr Microsurg

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Background: Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft. Methods: The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left–right position. Results: The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm. Conclusion: To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2–3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left–right position due to anatomical differences.

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The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis

Cited by 10 publications

References 72 publications

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Optimal Timing for Secondary Reconstruction of Head and Neck Defects after Free Flap Failure

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study

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