Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center, Department of Plastic and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
Microsurgery. 2019 Jul;39(5):463-475. doi: 10.1002/micr.30460. Epub 2019 Apr 19.
The aim of this study was to evaluate outcome and safety of free flaps to the upper extremity by pooled, summarized rates, compared with the existing pooled results of the lower extremity from literature, and to improve the level of evidence in a meta-analysis.
A literature search of PubMed and Embase was conducted addressing publications between January 2000 and April 2018. Publications were selected by inclusion/exclusion criteria on safety and outcome. Postoperative complications were statistically analyzed: flap loss, vessel thrombosis; recipient-site infection, hematoma, seroma, wound dehiscence, dysesthesia; donor-site morbidity.
Two hundred and seventy-nine patients with 283 free flaps from 23 publications were extracted and eligible for this meta-analysis. The predominant donor site was the lower extremity (56%), with the anterolateral thigh flap as the major workhorse (30%). The summarized rate of total and partial flap loss was 6.0% (95% CI = 3.0-9.0%, P = 1.0000) and 8.0% (95% CI = 6.0-13.0%, P = 0.9973), respectively. The rate of arterial and venous thrombosis was 5.0% (95% CI = 3.0-9.0%, P = 0.9999) and 8.0% (95% CI = 9.0-37.0%, P = 0.9804), respectively. Complication rates of recipient site were: early infection with 7.0% (95% CI = 4.0-11.0%, P = 0.9788), hematoma with 6.0% (95% CI = 3.0-8.0%, P = 1.0000), seroma with 6.0% (95% CI = 4.0-10.0%, P = 0.9948), dehiscence with 7.0% (95% CI = 4.0-11.0%, P = 0.9988), and dysesthesia with 6% (95% CI = 4.0-10.0%, P = 0.9988). The rate of donor-site morbidity was 14% (95% CI = 8.0-21.0%, P = 0.0895).
Soft tissue free flaps to the upper extremity have comparable success rates, but higher perioperative complication rates (e.g., partial flap loss, infection, and wound dehiscence) compared to the pooled data of lower extremity reconstruction from existing meta-analysis.
本研究旨在通过汇总、总结的比率，评估上肢游离皮瓣的结果和安全性，并与现有文献中下肢游离皮瓣的汇总结果进行比较，并通过荟萃分析提高证据水平。
对 2000 年 1 月至 2018 年 4 月的 PubMed 和 Embase 文献进行了检索，以评估安全性和结果。根据纳入/排除标准选择术后并发症：皮瓣失活、血管血栓形成；受区感染、血肿、血清肿、伤口裂开、感觉异常；供区并发症。
从 23 篇文献中提取了 279 例 283 例游离皮瓣患者，符合本荟萃分析的条件。主要供区为下肢（56%），以股前外侧皮瓣为主要工作皮瓣（30%）。总皮瓣和部分皮瓣失活率分别为 6.0%（95%CI=3.0-9.0%，P=1.0000）和 8.0%（95%CI=6.0-13.0%，P=0.9973）。动脉和静脉血栓形成的发生率分别为 5.0%（95%CI=3.0-9.0%，P=0.9999）和 8.0%（95%CI=9.0-37.0%，P=0.9804）。受区并发症发生率为：早期感染 7.0%（95%CI=4.0-11.0%，P=0.9788），血肿 6.0%（95%CI=3.0-8.0%，P=1.0000），血清肿 6.0%（95%CI=4.0-10.0%，P=0.9948），裂开 7.0%（95%CI=4.0-11.0%，P=0.9988），感觉异常 6.0%（95%CI=4.0-10.0%，P=0.9988）。供区并发症发生率为 14%（95%CI=8.0-21.0%，P=0.0895）。
与现有荟萃分析中下肢重建的汇总数据相比，上肢游离皮瓣的软组织成功率相当，但围手术期并发症发生率较高（如部分皮瓣失活、感染和伤口裂开）。
