Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York.
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Reconstr Microsurg. 2022 Jun;38(5):378-389. doi: 10.1055/s-0041-1733978. Epub 2021 Aug 28.
Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction.
A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap.
A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1-8%). No significant heterogeneity was present across studies (Q statistic 22.12, = 0.14; = 27.68%, = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm, respectively. The area of the skin paddles was 117 cm.
The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.
目前报道关于旋髂深动脉（DCIA）游离皮瓣的研究仅限于少数患者和应用领域。本综述旨在评估 DCIA 游离皮瓣在重建中的可靠性和多功能性。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用 PubMed、Web of Science、Cochrane 中心和 SCOPUS 进行全面综述。采用荟萃数据分析评估应用 DCIA 游离皮瓣的结果。
共纳入 445 例 DCIA 游离皮瓣。主要受区为头颈部（72.35%）、下肢（20.67%）和上肢（6.74%）。重建的主要适应证为肿瘤切除（73.8%）和创伤（17.43%）。有 50 例非 DCIA 皮瓣需要完成几个缺损的最终重建。应用 DCIA 游离皮瓣的皮瓣失败率为 4%（95%置信区间：1-8%）。研究间无显著异质性（Q 统计量 22.12， = 0.14； = 27.68%， = 0.139）。头颈部和肢体重建的并发症发生率分别为 57.37%和 40.16%。骨瓣的平均长度和表面积分别为 7.79 cm 和 22.8 cm，皮瓣的面积为 117 cm。
DCIA 游离皮瓣已被证明是头颈部和短-中尺寸肢体缺损的多功能重建替代方法。然而，功能的复杂性、受区位置和潜在的大缺损可能会影响将 DCIA 游离皮瓣作为头颈部和广泛肢体缺损的初始重建选择。
