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. 2023 Oct 9;11(10):e5311.
doi: 10.1097/GOX.0000000000005311. eCollection 2023 Oct.

Free Flap Failure and Complications in Acute Burns: A Systematic Review and Meta-analysis

Julia A Kasmirski  1 , Mario Alessandri-Bonetti  1 , Hilary Liu  1 , Alain C Corcos  2 , Jenny A Ziembicki  2 , Guy M Stofman  1 , Francesco M Egro  2
Affiliations

Free Flap Failure and Complications in Acute Burns: A Systematic Review and Meta-analysis

Julia A Kasmirski et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Severe acute burn injuries represent a challenge to the reconstructive surgeon. Free flap reconstruction might be required in cases of significant critical structure exposure and soft tissue deficits, when local options are unavailable. This study aimed to determine the free flap complication rate in acute burn patients.

Methods: A systematic review and meta-analysis were conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on the International Prospective Register of Systematic Reviews database (CRD42023404478). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was the free flap failure rate.

Results: The study identified 31 articles for inclusion. A total of 427 patients (83.3% men, 16.7% women) accounting for 454 free flaps were included. The mean patient age was 36.21 [95% confidence interval (CI), 31.25-41.16]. Total free flap loss rate was 9.91% [95% CI, 7.48%-13.02%], and partial flap loss was 4.76% [95% CI, 2.66%-8.39%]. The rate of venous thrombosis was 6.41% [95% CI, 3.90%-10.36%] and arterial thrombosis was 5.08% [95% CI, 3.09%-8.26%]. Acute return to the operating room occurred in 20.63% [16.33%-25.71%] of cases. Stratified by body region, free flaps in the lower extremity had a failure rate of 8.33% [95% CI, 4.39%-15.24%], whereas in the upper extremity, the failure rate was 6.74% [95% CI, 3.95%-11.25%].

Conclusion: This study highlights the high risk of free flap complications and failure in acute burn patients.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information.

Figures

Fig. 1.
Fig. 1.
Prisma flow diagram.
Fig. 2.
Fig. 2.
Forest plot showing the prevalence of total free flap loss in acute burns.
Fig. 3.
Fig. 3.
Forest plot showing the prevalence of partial free flap loss in acute burns.
Fig. 4.
Fig. 4.
Forest plot showing the prevalence of arterial thrombosis of the free flap in acute burns.
Fig. 5.
Fig. 5.
Forest plot showing the prevalence of venous thrombosis of the free flap in acute burns.
Fig. 6.
Fig. 6.
Forest plot showing the prevalence of postoperative infection of the free flap in acute burns.
Fig. 7.
Fig. 7.
Forest plot showing the prevalence of need for acute return to the operating room.
Fig. 8.
Fig. 8.
Forest plot showing the prevalence of total free flap loss in upper extremity acute burns.
Fig. 9.
Fig. 9.
Forest plot showing the prevalence of total free flap loss in lower extremity acute burns.
Fig. 10.
Fig. 10.
Forest plot showing the prevalence of total free flap loss in electrical acute burns.
Fig. 11.
Fig. 11.
Forest plot showing the prevalence of total free flap loss in nonelectrical acute burns.
See this image and copyright information in PMC

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