除了穿鞋方便和体积方面，脂肪筋膜皮瓣相对于筋膜皮瓣并无额外益处：一项系统评价和荟萃分析。
No added benefits of adipofascial flaps over fasciocutaneous flaps except for footwear ease and bulkiness: A systematic review and meta-analysis.
作者信息
Raja Balgovind S, Vathulya Madhubari, Maheshwari Vikas, Gowda Aditya K S, Jain Akash, Kandwal Pankaj
机构信息
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India.
出版信息
J Clin Orthop Trauma. 2022 Aug 27;33:101999. doi: 10.1016/j.jcot.2022.101999. eCollection 2022 Oct.
PURPOSE
The fasciocutaneous (FC) flap or the axial flap consists of skin, subcutaneous tissue, and deep fascia. In the literature today, there is no evidence suggesting that either surgery is superior to the other in terms of outcome and complications. Reviews in the literature currently compare the outcomes of skin closure after Orthopedic surgeries. The meta-analysis aims to compare the clinical outcomes, complication rates, need for re-surgery, and donor site morbidity between the AF flaps and FC flaps. A null hypothesis that stated inferior outcomes of FC flaps along with more complication rates over AF flaps was kept at the start of the study.
METHODS
Cochrane Library, PubMed, Embase were searched until December 2020. The review included all original studies which compared the outcomes or complications between FC and AF flaps. The quality of studies was assessed using the Minors score.
RESULTS
A total of 7 original studies with AF and FC flap procedures of which 136 underwent FC flap and 212 underwent AF flap. The pooled data meta-analysis and the subgroup analysis of these studies found no standardized protocol for reporting the outcomes or the cosmetic outcome of the flap surgery. The adipofascial group showed overall shorter operative time, less bulky flap and ability to wear footwear. Also the complications did not differ in both groups with respect to flap loss, complication following surgery, wound dehiscence, wound closure, donor site complications.
CONCLUSION
The current meta-analysis reveals that there is no added benefit of using AF flaps over the FC flaps. The rates of partial or total flap necrosis along with donor site morbidities and successful wound closure and overall complication rates were similar between the two groups. However, there is evidence to support the superiority of AF flaps over the FC variety with respect to ease of wearing footwear and a less bulky flap.
LEVEL OF EVIDENCE
Level 1 Systematic review and meta-analysis.
目的
筋膜皮瓣（FC）或轴型皮瓣由皮肤、皮下组织和深筋膜组成。在当今的文献中，没有证据表明这两种手术在疗效和并发症方面哪一种优于另一种。目前文献综述比较了骨科手术后皮肤闭合的效果。这项荟萃分析旨在比较轴型皮瓣（AF）和筋膜皮瓣在临床疗效、并发症发生率、再次手术需求以及供区发病率方面的差异。在研究开始时设定了一个零假设，即筋膜皮瓣的疗效较差且并发症发生率高于轴型皮瓣。
方法
检索Cochrane图书馆、PubMed、Embase直至2020年12月。该综述纳入了所有比较筋膜皮瓣和轴型皮瓣疗效或并发症的原始研究。使用Minor评分评估研究质量。
结果
共有7项关于轴型皮瓣和筋膜皮瓣手术的原始研究，其中136例接受了筋膜皮瓣手术，212例接受了轴型皮瓣手术。这些研究的汇总数据荟萃分析和亚组分析发现，对于皮瓣手术的疗效或美容效果，没有标准化的报告方案。脂肪筋膜组总体手术时间较短，皮瓣较薄，且能穿鞋子。此外，两组在皮瓣坏死、术后并发症、伤口裂开、伤口闭合、供区并发症方面的并发症情况并无差异。
结论
目前的荟萃分析表明，使用轴型皮瓣相对于筋膜皮瓣没有额外的益处。两组之间部分或完全皮瓣坏死率、供区发病率、伤口成功闭合率和总体并发症发生率相似。然而，有证据支持轴型皮瓣在穿鞋子的便利性和皮瓣较薄方面优于筋膜皮瓣。
证据水平
1级系统综述和荟萃分析。
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