Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany.
Institute of Medical Informatics, University Hospital RWTH Aachen, 52074, Aachen, Germany.
Syst Rev. 2024 Feb 26;13(1):74. doi: 10.1186/s13643-024-02471-x.
The radial forearm free flap (RFFF) serves as a workhorse for a variety of reconstructions. Although there are a variety of surgical techniques for donor site closure after RFFF raising, the most common techniques are closure using a split-thickness skin graft (STSG) or a full-thickness skin graft (FTSG). The closure can result in wound complications and function and aesthetic compromise of the forearm and hand. The aim of the planned systematic review and meta-analysis is to compare the wound-related, function-related and aesthetics-related outcome associated with full-thickness skin grafts (FTSG) and split-thickness skin grafts (STSG) in radial forearm free flap (RFFF) donor site closure.
A systematic review and meta-analysis will be conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be followed. Electronic databases and platforms (PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI)) and clinical trial registries (ClinicalTrials.gov, the German Clinical Trials Register, the ISRCTN registry, the International Clinical Trials Registry Platform) will be searched using predefined search terms until 15 January 2024. A rerun of the search will be carried out within 12 months before publication of the review. Eligible studies should report on the occurrence of donor site complications after raising an RFFF and closure of the defect. Included closure techniques are techniques that use full-thickness skin grafts and split-thickness skin grafts. Excluded techniques for closure are primary wound closure without the use of skin graft. Outcomes are considered wound-, functional-, and aesthetics-related. Studies that will be included are randomized controlled trials (RCTs) and prospective and retrospective comparative cohort studies. Case-control studies, studies without a control group, animal studies and cadaveric studies will be excluded. Screening will be performed in a blinded fashion by two reviewers per study. A third reviewer resolves discrepancies. The risk of bias in the original studies will be assessed using the ROBINS-I and RoB 2 tools. Data synthesis will be done using Review Manager (RevMan) 5.4.1. If appropriate, a meta-analysis will be conducted. Between-study variability will be assessed using the I index. If necessary, R will be used. The quality of evidence for outcomes will eventually be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
This study's findings may help us understand both closure techniques' complication rates and may have important implications for developing future guidelines for RFFF donor site management. If available data is limited and several questions remain unanswered, additional comparative studies will be needed.
The protocol was developed in line with the PRISMA-P extension for protocols and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17 September 2023 (registration number CRD42023351903).
游离桡侧前臂皮瓣（RFFF）是多种重建的首选。尽管有多种用于 RFFF 升高后的供区关闭的手术技术，但最常见的技术是使用全厚皮片移植（FTSG）或中厚皮片移植（STSG）进行关闭。这种闭合会导致伤口并发症以及前臂和手部的功能和美学受损。本计划系统评价和荟萃分析的目的是比较全厚皮片（FTSG）和中厚皮片（STSG）在桡侧前臂游离皮瓣（RFFF）供区关闭中的与伤口相关、与功能相关和与美学相关的结果。
将进行系统评价和荟萃分析。将遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。将使用预定义的搜索词搜索电子数据库和平台（PubMed、Embase、Scopus、Web of Science、Cochrane 对照试验中心注册库（CENTRAL）、中国国家知识基础设施（CNKI））和临床试验注册处（ClinicalTrials.gov、德国临床试验注册处、ISRCTN 注册处、国际临床试验注册平台），直到 2024 年 1 月 15 日。将在发布综述前 12 个月内对搜索结果进行重新运行。应报告升高 RFFF 和关闭缺损后供区并发症的发生情况。纳入的闭合技术是使用全厚皮片和中厚皮片的技术。排除的闭合技术是不使用皮片的原发性伤口闭合。结果被认为是与伤口、功能和美学相关的。纳入的研究是随机对照试验（RCT）和前瞻性和回顾性比较队列研究。将排除病例对照研究、无对照组研究、动物研究和尸体研究。两名评审员将对每项研究进行盲法筛选。第三名评审员解决分歧。原始研究的偏倚风险将使用 ROBINS-I 和 RoB 2 工具进行评估。使用 Review Manager（RevMan）5.4.1 进行数据综合。如果合适，将进行荟萃分析。使用 I 指数评估研究间的变异性。如果需要，将使用 R 进行分析。最终将使用推荐评估、制定和评估（GRADE）方法评估结局的证据质量。
本研究的结果可能有助于我们了解两种闭合技术的并发症发生率，并可能对制定游离桡侧前臂皮瓣供区管理的未来指南具有重要意义。如果可用数据有限且仍有几个问题未得到解答，则需要进行更多的比较研究。
该方案是根据 PRISMA-P 扩展协议制定的，并于 2023 年 9 月 17 日在国际前瞻性系统评价登记处（PROSPERO）注册（注册号 CRD42023351903）。
