Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Microsurgery. 2024 Jan;44(1):e31081. doi: 10.1002/micr.31081. Epub 2023 Jul 2.
Supermicrosurgical flaps based on perforator-to-perforator microanastomoses have been described for lower limb reconstruction. This approach offers the benefit of raising short pedicles while sparing axial vessels, which effectively enables complex reconstructive techniques in comorbid patients at high risk of reconstructive failure. The aim of our study is to assess the surgical outcomes of perforator-to-perforator based flaps in comparison to conventional free flaps for reconstructions of the lower limb district, through a systematic review of literature and meta-analysis.
A search on PubMed, Embase, Cohrane, and Web of Science was performed between March-July 2022. No restrictions were placed on study date. Only English manuscripts were assessed. Reviews, short communications, letters, correspondence were excluded after reviewing their references for potentially relevant studies. A Bayesian approach was used to conduct the meta-analysis comparing flap-related outcomes.
From 483 starting citations, 16 manuscripts were included for full-text analysis in the review, and three were included in the meta-analysis. Out of 1556 patients, 1047 received a perforator-to-perforator flap. Complications were reported in 119 flaps (11.4%), which included total flap failure in 71 cases (6.8%), partial flap failure in 47 cases (4.5%). Overall flap complications had a HR of 1.41 (0.94-2.11; 95% C.I.). Supermicrosurgical and conventional microsurgical reconstructions were not associated with statistically significant differences (p = .89).
Our evidence supports the safety of surgical outcomes, with acceptable flap complication rates. Nevertheless, these findings are limited by poor overall quality which must be addressed and used to encourage higher-level evidence in the field.
基于穿支吻合的超显微皮瓣已被用于下肢重建。这种方法的优点是可以在保留轴心血管的情况下提高短蒂皮瓣，从而使复杂的重建技术能够应用于合并症患者和高重建失败风险患者。我们的研究目的是通过系统回顾和荟萃分析，评估穿支吻合皮瓣与传统游离皮瓣在下肢重建方面的手术结果。
我们于 2022 年 3 月至 7 月在 PubMed、Embase、Cochrane 和 Web of Science 上进行了检索。未对研究日期进行限制。仅评估英文手稿。在审查其参考文献以寻找可能相关的研究后，排除了综述、短通讯、信件和通信。采用贝叶斯方法对皮瓣相关结局进行荟萃分析。
从 483 条初始引文，有 16 篇文章纳入综述的全文分析，有 3 篇文章纳入荟萃分析。在 1556 例患者中，有 1047 例接受了穿支吻合皮瓣。有 119 个皮瓣（11.4%）出现并发症，包括 71 例（6.8%）完全皮瓣失败，47 例（4.5%）部分皮瓣失败。总的皮瓣并发症的 HR 为 1.41（0.94-2.11；95% CI）。超显微和传统显微重建之间无统计学显著差异（p =.89）。
我们的证据支持手术结果的安全性，具有可接受的皮瓣并发症发生率。然而，这些发现受到整体质量较差的限制，必须加以解决，并鼓励该领域更高水平的证据。
