Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Plastic Surgery, South Shore Regional Hospital, Bridgewater, Canada.
J Reconstr Microsurg. 2019 Jun;35(5):362-371. doi: 10.1055/s-0038-1677012. Epub 2019 Jan 29.
The necessity for routine preoperative imaging for free fibula harvest is controversial. The primary objective of this meta-analysis is to determine if lower extremity angiography is necessary to detect abnormalities that may alter flap selection. The secondary objective is to determine if physical examination alone is sufficient to predict these abnormalities.
A literature search was performed using Cochrane, CENTRAL, MEDLINE, CINAHL, and EMBASE. Studies were selected for inclusion if they included patients undergoing free fibula flap harvest with preoperative imaging, with or without physical examination findings. Data extraction was performed independently and in duplicate, including a change in flap selection and the level of agreement between physical examination and imaging. Pooled proportions were calculated using a random-effects model and 95% confidence intervals (CI).
Sixteen studies were included for analysis. Mean sample size was 42 patients (range: 5-123). Included studies were of low methodologic quality. Pooled proportion of patients who had flap selection change secondary to abnormalities identified on preoperative angiography was 20.1% (95% CI: 9.6-33.2%). A pooled proportion of 71.5% (95% CI: 5-88.7%) of cases requiring change in flap selection was missed by physical examination findings alone.
There is low-quality evidence suggesting a necessity for routine preoperative angiography for all patients undergoing free fibula flap harvest. Physical examination alone is insufficient in detecting vascular abnormalities that may result in limb compromise or an inability to successfully harvest a free fibula. Further investigation is warranted for cost-effectiveness of preoperative imaging protocols.
对于游离腓骨采集术，是否需要常规进行术前影像学检查存在争议。本荟萃分析的主要目的是确定下肢血管造影是否有必要检测可能改变皮瓣选择的异常。次要目标是确定单独的体格检查是否足以预测这些异常。
使用 Cochrane、CENTRAL、MEDLINE、CINAHL 和 EMBASE 进行文献检索。如果研究纳入了接受游离腓骨皮瓣采集术且术前进行影像学检查（无论是否有体格检查结果）的患者，则将其纳入研究。独立且重复进行数据提取，包括皮瓣选择的改变以及体格检查与影像学之间的一致性程度。使用随机效应模型和 95%置信区间（CI）计算汇总比例。
纳入 16 项研究进行分析。平均样本量为 42 例患者（范围：5-123 例）。纳入的研究方法质量较低。因术前血管造影发现的异常而导致皮瓣选择改变的患者比例汇总为 20.1%（95%CI：9.6-33.2%）。单独的体格检查发现漏诊了 71.5%（95%CI：5-88.7%）需要改变皮瓣选择的病例。
有低质量证据表明，对于所有接受游离腓骨皮瓣采集术的患者，均有必要进行常规术前血管造影。单独的体格检查不足以检测可能导致肢体受损或无法成功采集游离腓骨的血管异常。需要进一步研究术前影像学检查方案的成本效益。
