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. 2022 Mar 11;11(6):1557.
doi: 10.3390/jcm11061557.

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

Vladimir Mégevand  1 , Domizio Suva  2 , Morad Mohamad  2 , Didier Hannouche  2 , Daniel F Kalbermatten  1 , Carlo M Oranges  1
Affiliations

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

Vladimir Mégevand et al. J Clin Med. .

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.

Keywords: fasciocutaneous flap; free flap; lower extremity microvascular reconstruction; lower limb reconstruction; muscle flap.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Literature search flowchart.
Figure 2
Figure 2
Donor site morbidity.
Figure 3
Figure 3
Total flap loss.
Figure 4
Figure 4
Postoperative infection.
Figure 5
Figure 5
Partial flap loss.
Figure 6
Figure 6
Recipient site complication not implying flap loss.
Figure 7
Figure 7
Need for revision surgery.
See this image and copyright information in PMC

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