Free versus Pedicled Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies

Abstract

Introduction: Lower limb reconstruction is a complex task requiring expertise from a plastic surgeon. Free and pedicled flaps are valuable surgical strategies but evidence comparing both technique is scarce. Our aim is to synthetise all studies comparing outcomes between each flap type by conducting a meta-analysis to identify post-operative outcomes. Materials and Methods: A systematic review of pubmed, EMBASE, Cochrane library and world of science was conducted aiming at articles comparing outcomes of free versus pedicled flaps in lower limb reconstruction. Pooled analysis was conducted using the Mantel and Haenszel method with random effect analysis. Differences in outcomes were expressed as risk ratio with a 95% confidence interval. Results: Ten retrospective studies met the selection criteria. While flap necrosis rate did not differ significantly between techniques (RR 1.35, 95% CI 0.76-2.39, p = 0.31), partial flap necrosis rate was significantly lower in free flaps (RR 0.45, 95%CI 0.22-0.91, p = 0.03). Overall complication rate (RR 0.83, 95% CI 0.64-1.07, p = 0.16), and revision surgery rate (RR 1.38, 95% CI 0.55-3.50, p = 0.49) did not differ significantly between free and pedicled flaps. No significant difference was found in high aesthetic satisfaction rate (RR 1.76, 95% CI 0.57-5.41, p = 0.32) and post-operative infection rate (RR 0.85, 95%CI 0.55-1.33, p = 0.48). Conclusion: Despite important variability in the choice of flaps and outcomes reported among studies, free and pedicled flaps appear to be reliable surgical strategies in lower limb reconstruction with similar surgical outcomes.