Department of Hand, Plastic, and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Burn, Plastic and Reconstructive Surgery, Beijing Jishuitan Hospital, Beijing, China.
Microsurgery. 2021 Oct;41(7):688-696. doi: 10.1002/micr.30791. Epub 2021 Aug 6.
Compound flaps offer the advantage of one stage defect reconstruction respecting all relevant tissues and early functional recovery by optimal vascularity of all components. Due to its specific vascular anatomy and the three-dimensional donor site, compound flaps with bone components may result in higher complication rates compared to soft tissue compound flaps. The meta-analysis summarizes the available evidence and evaluates whether bone components are a risk factor for periprocedural complications in upper extremity multidimensional defect reconstruction.
PubMed and Embase were searched for all publications addressing compound free flaps for upper extremity defect reconstruction with bone or soft tissue components published between January 1988 and May 2018. The methodological quality was assessed with the American Society of Plastic Surgeons Evidence Rating Scale for Therapeutic Studies. Flap loss, thrombosis rate, early infection, hematoma, seroma, as well as donor site complications were extracted and analyzed.
Twelve out of 1157 potentially eligible studies (evidence-III) comprising 159 patients were finally included with publication bias for all summarized complication rates. Complication rates for flaps with/ without bone components were: total flap loss 5%, 95% CI = 3%-10% (6%/5%); partial flap loss 8%, 95% CI = 5%-15%, (9%/8%); arterial/venous thrombosis 7%, 95% CI = 4%-12%, (8%/5%)/14%, 95% CI = 9%-21% (16%/6%, P < .05) with higher risk for flaps with bone components; infection 6%, 95% CI = 3%-12% (6%/6%); hematoma 6%, 95% CI = 3%-11% (6%/5%); seroma 5%, 95% CI = 3%-10% (5%/5%); dehiscence 10%, 95% CI = 6%-17% (11%/9%).
Compound flaps for upper extremity defect reconstruction including bone components have a higher venous thrombosis rate compared to compound soft-tissue flaps.
复合皮瓣具有一期重建所有相关组织的优势，通过所有成分的最佳血供实现早期功能恢复。由于其特定的血管解剖结构和三维供区，与软组织复合皮瓣相比，带有骨成分的复合皮瓣可能会导致更高的并发症发生率。这项荟萃分析总结了现有证据，并评估了骨成分是否是上肢多维缺损重建中围手术期并发症的危险因素。
检索 1988 年 1 月至 2018 年 5 月期间发表的所有涉及上肢骨或软组织缺损重建的复合游离皮瓣的文献，文献地址为 PubMed 和 Embase。使用美国整形外科学会治疗研究证据等级量表评估方法学质量。提取并分析皮瓣丢失、血栓形成率、早期感染、血肿、血清肿以及供区并发症。
最终有 12 项（证据等级 III）共 159 例患者的研究（1157 项潜在符合条件的研究中）被纳入，所有汇总并发症发生率均存在发表偏倚。有/无骨成分皮瓣的并发症发生率如下：总皮瓣丢失 5%，95%可信区间= 3%-10%（6%/5%）；部分皮瓣丢失 8%，95%可信区间= 5%-15%（9%/8%）；动脉/静脉血栓形成 7%，95%可信区间= 4%-12%（8%/5%）/14%，95%可信区间= 9%-21%（16%/6%，P<0.05），骨成分皮瓣的风险更高；感染 6%，95%可信区间= 3%-12%（6%/6%）；血肿 6%，95%可信区间= 3%-11%（6%/5%）；血清肿 5%，95%可信区间= 3%-10%（5%/5%）；裂开 10%，95%可信区间= 6%-17%（11%/9%）。
上肢缺损重建中使用复合皮瓣（包含骨成分）会导致更高的静脉血栓形成率，与复合软组织皮瓣相比。
