Casal Diogo, Cunha Teresa, Pais Diogo, Videira Paula, Coloma Joana, Zagalo Carlos, Angélica-Almeida Maria, O'Neill João Goyri
Lisbon, Portugal.
From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
Plast Reconstr Surg. 2016 Aug;138(2):459-479. doi: 10.1097/PRS.0000000000002390.
Although unconventional perfusion flaps have been in clinical use since 1975, many surgeons are still deterred from using them, because of some reports of high necrosis rates.
The authors performed a systematic review and meta-analysis of all articles written in English, French, German, Spanish, and Portuguese on the clinical use of unconventional perfusion flaps and indexed to PubMed from 1975 until July 15, 2015.
A total of 134 studies and 1445 patients were analyzed. The estimated survival rate of unconventional perfusion flaps was 89.5 percent (95 percent CI, 87.3 to 91.3 percent; p < 0.001). Ninety-two percent of unconventional perfusion flaps (95 percent CI, 89.9 to 93.7 percent; p < 0.001) presented complete or nearly complete survival. Most defects mandating unconventional perfusion flap reconstruction were caused by trauma (63.6 percent), especially of the hand and fingers (75.1 percent). The main complication of all types of flaps was a variable degree of necrosis (7.5 percent of all unconventional perfusion flaps presented marginal necrosis; 9.2 percent and 5.5 percent had significant and complete necrosis, respectively). There was a positive correlation between the rate of postoperative infection and the need for a new flap (Pearson coefficient, 0.405; p = 0.001). Flaps used to reconstruct the upper limb showed better survival than those transferred to the head and neck or to the lower limb (p < 0.001).
Unconventional perfusion flaps show high survival rates and should probably be used more liberally, particularly in the realm of upper limb reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
尽管非传统灌注皮瓣自1975年起就已应用于临床，但由于一些关于高坏死率的报道，许多外科医生仍对使用它们有所顾虑。
作者对1975年至2015年7月15日期间发表在英文、法文、德文、西班牙文和葡萄牙文且被PubMed收录的有关非传统灌注皮瓣临床应用的所有文章进行了系统综述和荟萃分析。
共分析了134项研究和1445例患者。非传统灌注皮瓣的估计存活率为89.5%（95%置信区间，87.3%至91.3%；p<0.001）。92%的非传统灌注皮瓣（95%置信区间，89.9%至93.7%；p<0.001）呈现完全或近乎完全存活。大多数需要非传统灌注皮瓣重建的缺损是由创伤引起的（63.6%），尤其是手部和手指创伤（75.1%）。所有类型皮瓣的主要并发症是不同程度的坏死（所有非传统灌注皮瓣中7.5%出现边缘性坏死；分别有9.2%和5.5%出现明显坏死和完全坏死）。术后感染率与新皮瓣需求之间存在正相关（Pearson系数，0.405；p = 0.001）。用于重建上肢的皮瓣比转移到头颈部或下肢的皮瓣存活率更高（p<0.001）。
非传统灌注皮瓣显示出高存活率，可能应更广泛地使用，尤其是在上肢重建领域。
临床问题/证据级别：治疗性，V级
