Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety

BackgroundMicrosurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence. MethodsA systematic literature research was performed including studies between 2000 and 2014 in English, German, and Chinese (PubMed, EMBASE). Publications were selected applying inclusion/exclusion criteria. Postoperative complications were statistically analyzed with metaprop command of R GUI 3.0.1. ResultsAlltogether 30 articles overlooking 1,397 free flaps were included. The rate of total flap loss was 6.0% (95% confidence interval [CI]=4.0%-8.0%, P-Q (P values of Q statistics)=0.03); the thrombosis rate was 6.0% (95% CI=4.0%-9.0%, P-Q=0.01); the hematoma rate was 4.0% (95% CI=3.0%-5.0%, P-Q=0.79); the partial necrosis rate was 6.0% (95% CI=4.0%-10.0%, P-Q<0.01); the early infection rate was 4.0% (95% CI=2.0%-6.0%, P-Q=0.03), and the dehiscence rate was 3.0% (95% CI=2.0%-5.0%, P-Q=0.12). Reconstruction for diabetic foot may be not associated with a significant increase of procedural risk (Total flap loss rate=6%, 95% CI=3.0%-9.0%, P-Q=0.44). ConclusionsMicrosurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. (c) 2016 Wiley Periodicals, Inc. Microsurgery 36:511-524, 2016.