Department of Burns and Plastic Surgery, Wythenshawe Hospital, Southmoor Road, Manchester, UK.
Department of Hand, Plastic, Reconstructive and Burn Surgery, University of Tübingen, Tübingen, Germany.
Syst Rev. 2021 Sep 8;10(1):245. doi: 10.1186/s13643-021-01797-0.
In many units around the world, microsurgical free-tissue transfer represents the gold standard for reconstruction of significant soft tissue defects following cancer, trauma or infection. However, many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources, infrastructure or training required to perform any microsurgical procedures. Long-term international collaborations have been formed with annual short-term reconstructive missions conducting microsurgery. In the first instance, these provide reconstructive surgery to those who need it. In the longer-term, they offer an opportunity for teaching and the development of sustainable local services.
A PRISMA-compliant systematic review and meta-analysis will be performed. A comprehensive, predetermined search strategy will be applied to the MEDLINE and Embase electronic databases from inception to August 2021. All clinical studies presenting sufficient data on free-tissue transfer performed on short-term collaborative surgical trips (STCSTs) in LMICs will be eligible for inclusion. The primary outcomes are rate of free flap failure, rate of emergency return to theatre for free flap salvage and successful salvage rate. The secondary outcomes include postoperative complications, cost effectiveness, impact on training, burden of disease, legacy and any functional or patient reported outcome measures. Screening of studies, data extraction and assessments of study quality and bias will be conducted by two authors. Individual study quality will be assessed according to the Oxford Evidence-based Medicine Scales of Evidence 2, and risk of bias using either the 'Revised Cochrane risk of bias tool for randomized trials' (Rob2), the 'Risk of bias in non-randomized studies of interventions' (ROBINS-I) tool, or the National Institute for Health Quality Assessment tool for Case Series. Overall strength of evidence will be assessed according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
To-date the outcomes of microsurgical procedures performed on STCSTs to LMICs are largely unknown. Improved education, funding and allocation of resources are needed to support surgeons in LMICs to perform free-tissue transfer. STCSTs provide a vehicle for sustainable collaboration and training. Disseminating microsurgical skills could improve the care received by patients living with reconstructive pathology in LMICs, but this is poorly established. This study sets out a robust protocol for a systematic review designed to critically analyse outcomes.
PROSPERO 225613.
在世界上许多单位，显微游离组织移植是癌症、创伤或感染后重建大软组织缺损的金标准。然而，许多低收入和中等收入国家（LMICs）的重建单位尚未获得执行任何显微手术所需的资源、基础设施或培训。长期以来，国际合作已经形成，每年都有短期重建任务进行显微手术。在最初阶段，这些任务为有需要的人提供重建手术。从长远来看，它们为教学和可持续的本地服务发展提供了机会。
将进行符合 PRISMA 标准的系统评价和荟萃分析。将采用全面的、预先确定的搜索策略，对 MEDLINE 和 Embase 电子数据库进行搜索，检索时间为从建库至 2021 年 8 月。所有在低收入和中等收入国家的短期合作外科手术旅行（STCST）中报告了足够游离皮瓣移植数据的临床研究都将有资格纳入。主要结局是游离皮瓣失败率、因游离皮瓣挽救而紧急返回手术室的率和成功挽救率。次要结局包括术后并发症、成本效益、对培训的影响、疾病负担、遗产以及任何功能或患者报告的结果测量。两名作者将进行研究筛选、数据提取以及研究质量和偏倚评估。将根据牛津循证医学证据量表 2 评估单个研究的质量，使用“修订后的随机试验 Cochrane 偏倚风险工具（Rob2）”、“非随机干预研究的偏倚风险（ROBINS-I）工具”或国家卫生质量评估工具评估偏倚。病例系列。根据推荐评估、制定和评估（GRADE）方法评估总体证据强度。
迄今为止，在 STCST 中为 LMICs 执行的显微手术的结果在很大程度上是未知的。需要改善教育、资金和资源分配，以支持 LMICs 的外科医生进行游离皮瓣转移。STCST 为可持续合作和培训提供了手段。传播显微外科技能可以改善在 LMICs 接受重建病理治疗的患者的护理，但这一点尚未得到很好的证实。本研究制定了一个稳健的系统评价方案，旨在对结果进行严格分析。
PROSPERO 225613。
