Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Japan; Department of Surgery, Arthur Davison Children's Hospital, Ndola, Zambia.
Division of Epidemiology and Public Health, The University of Nottingham, Nottingham, United Kingdom.
J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2035-2048. doi: 10.1016/j.bjps.2022.04.028. Epub 2022 Apr 25.
Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa.
Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates.
Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84).
This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care.
Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
重建显微外科游离皮瓣技术通常是治疗多种复杂组织缺损的首选方法，涉及多个外科专业。然而，在低收入和中等收入国家，这种技术的应用还不够发达。本系统评价旨在评估在非洲进行的重建显微外科的临床应用和结果。
在 7 个数据库（PubMed、Web of Science、MEDLINE、CINAHL、Academic Search Complete、Embase 和 Google Scholar）中搜索报告在非洲进行的显微外科手术的研究。使用 Joanna Briggs 研究所的批判性评估工具评估偏倚风险，并使用 GRADE 方法评估证据质量。使用随机效应模型进行荟萃分析，以估计事件的合并比例及其 95%置信区间。主要结局是游离皮瓣成功率，次要结局是并发症和皮瓣成活率。
纳入了叙述性综述的 92 项研究和荟萃分析的 9 项研究。总共分析了 1976 年至 2020 年间来自 1327 名患者的 1376 例游离皮瓣。头颈部肿瘤重建占 30%，而乳房重建占 2%。皮瓣存活率的合并率为 89%（95%CI：0.84，0.93），并发症发生率为 51%（95%CI：0.36，0.65），游离皮瓣成活率为 45%（95%CI：0.08，0.84）。
这项荟萃分析表明，非洲的游离皮瓣成功率较高，与高收入国家报道的成功率相当。然而，相对较高的并发症发生率和较低的成活率表明需要改善围手术期护理。
于 2020 年 9 月 25 日在国际前瞻性系统评价登记处（PROSPERO）注册，编号为 CRD42020192344。
