Affiliation:
1. Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
2. Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
3. International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
Abstract
Abstract
Background Combined revascularization and free flap reconstruction is one treatment method for chronic limb-threatening ischemia (CLTI) with complex wounds. The purpose of this systematic review and meta-analysis was to investigate the characteristics of this combined procedure and to assess postoperative outcomes.
Methods A systematic search was performed across PubMed, Scopus, and the Web of Science for studies between January 2000 and February 2022. A random-effects meta-analysis for postoperative outcome was conducted.
Results Fifteen articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment. Our meta-analysis showed the following complication rates for short-term postoperative outcomes: 37% (95% confidence interval [CI], 18–53%; I
2 = 74%) for reoperation, 13% (95% CI, 2–24%; I
2 = 0%) for vascular thrombosis, 9% (95% CI, 0–17%; I
2 = 0%) for total flap failure, 8% (95% CI, 0–17%; I
2 = 0%) for partial flap failure, 4% (95% CI, 0–10%; I
2 = 0%) for amputation, and 3% (95% CI, 0–9%; I
2 = 0%) for 30-day mortality. The 1-, 3-, and 5-year limb salvage rates were 86% (95% CI, 78–92%), 81% (95% CI, 68–88%), and 71% (95% CI, 53–83%), respectively. The 1-, 3-, and 5-year patient survival rates were 93% (95% CI, 90–96%), 92% (95% CI, 77–97%), and 75% (95% CI, 50–88%), respectively.
Conclusion Combined revascularization and free flap reconstruction for CLTI with complex wounds was clearly effective for the long-term outcomes. However, this combined procedure should be considered on the assumption that the reoperation rate is high and that flap-related complications rate may be higher than lower extremity reconstruction of other etiologies.