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游离皮瓣与带蒂皮瓣用于手部重建:一项系统评价与荟萃分析。

Free versus pedicled flaps for hand reconstruction: A systematic review and meta-analysis.

作者信息

Alzahrani Haya Abdulaziz, Asiri Mohammed Nasser, Humedi Abdulsalam M, Alammar Juman, Alrashed Hajar, Hakami Faisal

机构信息

Faculty of Medicine, Al-Baha University, Jeddah, Saudi Arabia.

Assistant Professor of Plastic, Reconstructive, and Hand Surgery, Department of Surgery, Faculty of Medicine, Al-Baha University, Al-Baha, Saudi Arabia.

出版信息

JPRAS Open. 2025 May 16;45:278-288. doi: 10.1016/j.jpra.2025.05.004. eCollection 2025 Sep.

DOI:10.1016/j.jpra.2025.05.004
PMID:40697559
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12281028/
Abstract

BACKGROUND

Hand reconstruction is a critical component of plastic surgery, addressing congenital, traumatic, and degenerative conditions. Free and pedicled flaps are commonly used for hand defect repair.

AIM

This systematic review was to compare the outcomes of free versus pedicled flaps in hand reconstruction.

METHODS

a search was conducted in October 2024 across PubMed, Web of Science, and Ovid MEDLINE using keywords such as "free tissue flaps," "pedicled flaps," and "hand reconstruction." Eligible studies included randomized controlled trials, cohort studies, and clinical trials. Data on flap survival, complications, and patient satisfaction were extracted independently.

RESULTS

Nine studies involving 839 hands were included. Free flaps had a lower revision surgery rate (24 % vs. 61 %), while pedicled flaps showed fewer infections (8 % vs. 13 %) and less flap necrosis (8 % vs. 9 %).

CONCLUSION

Free flaps offer lower revision rates, while pedicled flaps present fewer complications. This systematic review represents level III evidence

摘要

背景

手部重建是整形外科的关键组成部分,可解决先天性、创伤性和退行性疾病。游离皮瓣和带蒂皮瓣常用于手部缺损修复。

目的

本系统评价旨在比较游离皮瓣和带蒂皮瓣在手部重建中的效果。

方法

2024年10月,在PubMed、科学网和Ovid MEDLINE数据库中进行检索,使用“游离组织皮瓣”、“带蒂皮瓣”和“手部重建”等关键词。符合条件的研究包括随机对照试验、队列研究和临床试验。独立提取皮瓣存活、并发症和患者满意度的数据。

结果

纳入9项研究,涉及839只手。游离皮瓣的翻修手术率较低(24%对61%),而带蒂皮瓣的感染较少(8%对13%),皮瓣坏死也较少(8%对9%)。

结论

游离皮瓣的翻修率较低,而带蒂皮瓣的并发症较少。本系统评价为III级证据

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/583c04bd1727/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/97bf6a975dd7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/13b63e7c0884/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/ea08b7649972/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/55dd3ca03687/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/583c04bd1727/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/97bf6a975dd7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/13b63e7c0884/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/ea08b7649972/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/55dd3ca03687/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b131/12281028/583c04bd1727/gr5.jpg

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本文引用的文献

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J Clin Med. 2022 Jun 25;11(13):3672. doi: 10.3390/jcm11133672.
2
The use of the posterior interosseous artery flap and anterolateral thigh flap for post-traumatic soft tissue reconstruction of the hand.应用骨间后动脉皮瓣和股前外侧皮瓣修复手部创伤后软组织缺损。
Medicine (Baltimore). 2021 Jul 2;100(26):e26517. doi: 10.1097/MD.0000000000026517.
3
Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap.
游离股前外侧深筋膜皮瓣修复手部软组织缺损。
Orthop Surg. 2021 May;13(3):758-767. doi: 10.1111/os.12948. Epub 2021 Mar 5.
4
Treatment of volar defects of the finger using dorsal digital-metacarpal flap versus free medial plantar artery flap: a comparative study.掌侧指固有动脉逆行岛状皮瓣与游离内侧足底动脉皮瓣修复手指掌侧缺损的比较研究
BMC Surg. 2021 Jan 22;21(1):52. doi: 10.1186/s12893-020-00994-3.
5
Current indications for abdominal-based flaps in hand and forearm reconstruction.腹部皮瓣在手和前臂重建中的适应证。
Injury. 2020 Dec;51(12):2916-2921. doi: 10.1016/j.injury.2020.02.105. Epub 2020 Feb 21.
6
A Comparative Study of Finger Pulp Reconstruction Using Free Distal Ulnar Artery Perforator Flaps and Reverse Dorsal Homodigital Island Flaps.游离尺动脉远侧穿支皮瓣与逆行指背同指岛状皮瓣修复指腹的对比研究
Ann Plast Surg. 2019 Dec;83(6):650-654. doi: 10.1097/SAP.0000000000002106.
7
Selecting a free flap for soft tissue coverage in lower extremity reconstruction.选择游离皮瓣进行下肢重建中的软组织覆盖。
Injury. 2019 Dec;50 Suppl 5:S32-S39. doi: 10.1016/j.injury.2019.10.045. Epub 2019 Oct 21.
8
Anatomical and Clinical Comparison of Small Free Flaps for Repairing Finger Skin Defects.用于修复手指皮肤缺损的游离小皮瓣的解剖学与临床比较
Ann Plast Surg. 2019 Dec;83(6):664-669. doi: 10.1097/SAP.0000000000001933.
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J Otolaryngol Head Neck Surg. 2019 Mar 14;48(1):13. doi: 10.1186/s40463-019-0334-y.
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