Muscle vs. Fasciocutaneous Microvascular Free Flaps for Lower Limb Reconstruction: A Meta-Analysis of Comparative Studies.

Vladimir Mégevand,Carlo M Oranges,Domizio Suva,Daniel F Kalbermatten,Didier Hannouche,Morad Mohamad

doi:10.3390/jcm11061557

Vladimir Mégevand, Carlo M Oranges + Show 4 more

Open Access

https://doi.org/10.3390/jcm11061557

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Abstract

(1) Background: Lower extremity microvascular reconstruction aims at restoring function and preventing infection while ensuring optimal cosmetic outcomes. Muscle (M) or fasciocutaneous (FC) free flaps are alternatively used to treat similar conditions. However, it is unclear whether one option might be considered superior in terms of clinical outcomes. We performed a meta-analysis of studies comparing M and FC flaps to evaluate this issue. (2) Methods: The PRISMA guidelines were followed to perform a systematic search of the English literature. We included all articles comparing M and FC flap reconstructions for lower limb soft tissue defects following trauma, infection, or tumor resection. We considered flap loss, postoperative infection, and donor site morbidity as primary outcomes. Secondary outcomes included minor recipient site complications and the need for revision surgery. (3) Results: A total of 10 articles involving 1340 patients receiving 1346 flaps were retrieved, corresponding to 782 M flaps and 564 FC flaps. The sizes of the studies ranged from 39 to 518 patients. We observed statistically significant differences (p < 0.05) in terms of donor site morbidity and total flap loss with better outcomes for FC free flaps. Moreover, the majority of authors preferred FC flaps because of the greater aesthetic satisfaction and lesser rates of postoperative infection. (4) Conclusion: Our data suggest that both M and FC free flaps are safe and effective options for lower limb reconstruction following trauma, infection, or tumor resection, although FC flaps tend to provide stronger clinical benefits. Further research should include larger randomized studies to confirm these data.

Highlights

Surgical management of complex soft tissue defects of the lower extremity has markedly improved in the last three decades through the application of free tissue transfer, substantially reducing the need for amputations [1]
The most commonly harvested M free flaps were Latissimus Dorsi, Gracilis, Rectus Abdominis, and Vastus Lateralis, while FC free flaps were mostly represented by anterolateral thigh, radial forearm, and lateral arm flaps
Four studies [5,12,13,17] involving a total of 376 patients reported results on donor site morbidity following M or FC free flaps, and pooled analysis showed a significant difference between the two treatment groups (RR 2.55, 95% CI 1.61–4.04, p < 0.01; Figure 2) with M flaps showing higher rates of donor site morbidity

Summary

Introduction

Surgical management of complex soft tissue defects of the lower extremity has markedly improved in the last three decades through the application of free tissue transfer, substantially reducing the need for amputations [1]. Two foremost surgical approaches are alternatively used and have been widely described to assess complex lower limb soft tissue defects: muscle (M) free flaps and fasciocutaneous (FC) free flaps. Both methods have been proven to be safe and effective regarding limb salvage and functional recovery. Latissimus Dorsi, Gracilis, Serratus Anterior, and Rectus Abdominis muscle flaps are most commonly used according to the literature [4]

Results

Discussion

Conclusion