Mégevand Vladimir, Suva Domizio, Mohamad Morad, Hannouche Didier, Kalbermatten Daniel F, Oranges Carlo M
Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.
Department of Orthopedic Surgery, Geneva University Hospitals, University of Geneva, 1205 Geneva, Switzerland.
J Clin Med. 2022 Mar 11;11(6):1557. doi: 10.3390/jcm11061557.
(1) Background: Lower extremity microvascular reconstruction aims at restoring function and preventing infection while ensuring optimal cosmetic outcomes. Muscle (M) or fasciocutaneous (FC) free flaps are alternatively used to treat similar conditions. However, it is unclear whether one option might be considered superior in terms of clinical outcomes. We performed a meta-analysis of studies comparing M and FC flaps to evaluate this issue. (2) Methods: The PRISMA guidelines were followed to perform a systematic search of the English literature. We included all articles comparing M and FC flap reconstructions for lower limb soft tissue defects following trauma, infection, or tumor resection. We considered flap loss, postoperative infection, and donor site morbidity as primary outcomes. Secondary outcomes included minor recipient site complications and the need for revision surgery. (3) Results: A total of 10 articles involving 1340 patients receiving 1346 flaps were retrieved, corresponding to 782 M flaps and 564 FC flaps. The sizes of the studies ranged from 39 to 518 patients. We observed statistically significant differences (p < 0.05) in terms of donor site morbidity and total flap loss with better outcomes for FC free flaps. Moreover, the majority of authors preferred FC flaps because of the greater aesthetic satisfaction and lesser rates of postoperative infection. (4) Conclusion: Our data suggest that both M and FC free flaps are safe and effective options for lower limb reconstruction following trauma, infection, or tumor resection, although FC flaps tend to provide stronger clinical benefits. Further research should include larger randomized studies to confirm these data.
(1) 背景：下肢微血管重建旨在恢复功能、预防感染，同时确保达到最佳的美容效果。肌肉（M）或筋膜皮（FC）游离皮瓣可交替用于治疗类似病症。然而，就临床结果而言，尚不清楚哪种选择可能更具优势。我们对比较M皮瓣和FC皮瓣的研究进行了荟萃分析，以评估这一问题。(2) 方法：遵循PRISMA指南对英文文献进行系统检索。我们纳入了所有比较M皮瓣和FC皮瓣用于创伤、感染或肿瘤切除后下肢软组织缺损重建的文章。我们将皮瓣丢失、术后感染和供区并发症视为主要结局。次要结局包括受区轻微并发症和翻修手术的必要性。(3) 结果：共检索到10篇文章，涉及1340例接受1346个皮瓣的患者，其中782个为M皮瓣，564个为FC皮瓣。研究规模从39例至518例患者不等。我们观察到在供区并发症和皮瓣总丢失方面存在统计学显著差异（p < 0.05），FC游离皮瓣的结局更好。此外，大多数作者更倾向于FC皮瓣，因为其美学满意度更高且术后感染率更低。(4) 结论：我们的数据表明，对于创伤、感染或肿瘤切除后的下肢重建，M游离皮瓣和FC游离皮瓣都是安全有效的选择，尽管FC皮瓣往往能带来更强的临床益处。进一步的研究应包括更大规模的随机研究以证实这些数据。
