Celie Karel-Bart, Guo Sarah, Raya Jessica, Fahradyan Artur, Carey Joseph, Salibian Ara A
Division of Plastic and Reconstructive Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
University of Southern California, Keck School of Medicine, Los Angeles, USA.
Microsurgery. 2024 Feb;44(2):e31144. doi: 10.1002/micr.31144.
Free tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross-leg flap cannot provide enough coverage, a cross-leg free flap (CLFF) is a limb-saving alternative. The aim of this study is to conduct a systematic review of the literature published on the CLFF.
We conducted a systematic review of articles describing the CLFF, according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Inclusion criteria included articles with primary data on the CLFF. Exclusion criteria included those describing pedicled cross-leg flaps or lacking complete data. Data analysis was performed using SPSS 29.0.
Our review included 28 articles encompassing 130 patients who underwent free tissue transfer. Most were male (63.8%) with a mean age of 32.4 years. Latissimus dorsi was the most common flap type (30.0%), followed by vertical rectus myocutaneous (20.0%). Average flap size was 301.8 cm , with trauma in the lower third of the leg being the most common indication (73.1%). The contralateral posterior tibialis was the most common recipient artery (84.1%) followed by the anterior tibialis (9.5%). Complications included amputation (1.4%), partial graft loss, thrombosis, hematoma, prolonged pain, nonunion, and seroma; a forest plot was used to illustrate the low overall adverse events rate. Although bivariate analysis identified age, flap size, type, location, and donor site as variables significantly impacting the incidence of complications (p < .05), this was not sustained in a multivariate logistic regression model.
The CLFF remains an excellent option for limb salvage when a suitable recipient vessel is unavailable. Our review demonstrates 1.4% flap failure and an acceptable complication rate. While most cases in our review describe muscle flaps, we report a complex case of limb salvage using an unusually large anterolateral thigh flap.
游离组织移植是下肢软组织损伤的主要治疗方法。当传统的交腿皮瓣无法提供足够的覆盖面积时，交腿游离皮瓣（CLFF）是一种挽救肢体的替代方法。本研究的目的是对关于CLFF的已发表文献进行系统综述。
我们根据系统评价和Meta分析的首选报告项目指南，对描述CLFF的文章进行了系统综述。纳入标准包括具有CLFF原始数据的文章。排除标准包括描述带蒂交腿皮瓣或缺乏完整数据的文章。使用SPSS 29.0进行数据分析。
我们的综述纳入了28篇文章，涉及130例行游离组织移植的患者。大多数为男性（63.8%），平均年龄32.4岁。背阔肌是最常见的皮瓣类型（30.0%），其次是腹直肌肌皮瓣（20.0%）。平均皮瓣面积为301.8平方厘米，小腿下1/3创伤是最常见的适应证（73.1%）。对侧胫后动脉是最常见的受区动脉（84.1%），其次是胫前动脉（9.5%）。并发症包括截肢（1.4%）、部分移植皮瓣丢失、血栓形成、血肿、长期疼痛、骨不连和血清肿；采用森林图来说明总体不良事件发生率较低。虽然双变量分析确定年龄、皮瓣大小、类型、位置和供区为显著影响并发症发生率的变量（p<0.05），但在多变量逻辑回归模型中这一结果未得到维持。
当没有合适的受区血管时，CLFF仍然是挽救肢体的极佳选择。我们的综述显示皮瓣失败率为1.4%，并发症发生率可接受。虽然我们综述中的大多数病例描述的是肌皮瓣，但我们报告了一例使用异常大的股前外侧皮瓣进行肢体挽救的复杂病例。
