Elemosho Abdulaziz, Raborn Macdonald Layne N, Bell Derek E, Janis Jeffrey E
Department of Plastic and Reconstructive Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Division of Plastic Surgery, University of Rochester Medical Center, Rochester, New York, USA.
Microsurgery. 2025 Sep;45(6):e70104. doi: 10.1002/micr.70104.
BACKGROUND: Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction. METHODS: A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model. RESULTS: Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (I = 0% [95% CI: 97.7-99.6]) of pedicled and 90.1% (I = 82.8% [95% CI: 62.7-100]) of free flap reconstructions, recurring in 1.8% (I = 0% [95% CI: 0.7-3.3]) at sites reconstructed with pedicled flaps and 0.6% (I = 0% [95% CI: 0.1-1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (I = 0% [95% CI: 0.6-2.7]) and 2.9% (I = 37.9% [95% CI: 0.9-5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (I = 65.1% [95% CI: 3.4-11.5]) and 5.2% (I = 65% [95% CI: 1.7-10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (p = 0.50), contracture recurrence (p = 0.15), total flap loss (p = 0.18) or partial flap loss (p = 0.31) regardless of the flap type used. CONCLUSIONS: Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.
背景：挛缩复发是烧伤重建中常见的挫折，尤其是对于严重或大面积挛缩。基于皮瓣的烧伤重建已被证明可降低挛缩复发率。本研究旨在总结和评估用于烧伤后关节挛缩重建的基于皮瓣技术的效果。 方法：按照PRISMA指南进行系统评价。检索的数据库包括PUBMED、EMBASE、Scopus和科学网。纳入描述使用具有已知血供的皮瓣重建烧伤后关节挛缩的文章。排除数据不完整、涉及多个解剖部位挛缩、病例报告和非英文文章的研究。提取患者人口统计学、皮瓣类型、并发症和挛缩解决情况的数据。使用DerSimonian和Laird随机效应模型进行比例荟萃分析。 结果：在筛选的850项研究中，27项符合纳入标准。报告了830例关节挛缩的重建情况。带蒂皮瓣重建中98.9%（I² = 0% [95% CI：97.7 - 99.6]）的挛缩得到解决，游离皮瓣重建中90.1%（I² = 82.8% [95% CI：62.7 - 100]）的挛缩得到解决，带蒂皮瓣重建部位的复发率为1.8%（I² = 0% [95% CI：0.7 - 3.3]），游离皮瓣重建部位的复发率为0.6%（I² = 0% [95% CI：0.1 - 1.7]）。皮瓣并发症发生率较低，带蒂皮瓣和游离皮瓣的总皮瓣丢失率分别为1.5%（I² = 0% [95% CI：0.6 - 2.7]）和2.9%（I² = 37.9% [95% CI：0.9 - 5.8]）。带蒂皮瓣和游离皮瓣的部分皮瓣丢失率分别为6.9%（I² = 65.1% [95% CI：3.4 - 11.5]）和5.2%（I² = 65% [95% CI：1.7 - 10.4]）。无论使用何种皮瓣类型，挛缩解决率（p = 0.50）、挛缩复发率（p = 0.15）、总皮瓣丢失率（p = 曲0.18）或部分皮瓣丢失率（p = 0.31）均无显著差异。 结论：使用基于皮瓣的技术进行烧伤挛缩重建用于关节时并发症极少，挛缩复发率低。烧伤挛缩部位的带蒂皮瓣和游离皮瓣重建效果相似。
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