SLR - January 2020 - Bruce Bever
Reference: Rodriguez-Collazo, E., Khan, A., DiPierro, D., & Khan, I. (2018). A Systematic Review of Outcomes and Flap Selection Following Lower Extremity Free Tissue Transfer Versus Vascularized Perforator Pedicle Flap Transfer in Lower Limb Reconstruction. International Journal of Orthoplastic Surgery, 1(2), 55–66.Scientific Literature Review
Reviewed By: Bruce Bever, DPM
Residency Program: AMITA Health, St. Joseph Hospital – Chicago, IL
Podiatric Relevance: Lower limb reconstruction is gaining more and more prevalence within the podiatric surgery community. As our profession continues to evolve and deepen, the abilities and techniques required from today’s residents and tomorrow’s skilled surgeons, allow us to keep and continue to provide excellent specialized care for more complex patients. Soft tissue defects with etiologies including pressure, trauma and infectious processes are encountered frequently within our scope of practice. Understanding the treatment options; making complex clinical decisions and performing more specialized surgical interventions will result in increased quality of life, and preservation of limbs for our patients, beyond the function of a mere biologic prosthesis.
Methods: This paper is a systematic review of 72 topic-related studies from 2014-2017. Sixteen of the 72 met inclusion criteria. Those reviewed included patients who underwent lower limb reconstruction with a flap transfer for treatment of a soft tissue defect. Articles included contained information on age, type of reconstruction, total number of reconstructions, total number of patients, post operative outcomes, comorbidities and complications. Articles which did not focus on microsurgical reconstruction were excluded, as were single case reports, editorials and discussions. Reconstructive options were discussed in detail, comparing free tissue transfers to vascularized perforator pedicle flaps. The most-used free tissue transfer was latissimus dorsi, followed by anterolateral thigh, medial sural artery perforator and rectus abdominis. The most-noted vascularized perforator pedicle flaps reviewed by this study were the posterior tibial artery perforator, peroneal artery perforator, and fasciocutaneous sural. Several different flaps were then exemplified and reviewed based on placement, outcome and complications encountered during treatment.
Results: A total of 567 abstracts or titles were identified. Five hundred and two were rejected for not fulfilling the inclusion criteria. Seventy-two articles were then considered in the review; 55 failed to meet the review criteria, leaving 16 articles for review. Within the 16 articles, the results of 313 free tissue transfers and 742 vascularized pedicle flap transfers were examined and quantified. Complications rates and occurrence were discussed for the reviewed techniques.
Conclusions: The overall outcomes as examined did not point to a single superior pedicle flap or free tissue transfer, however, this paper remains a valuable resource. With multiple pedicle flaps and free tissue transfers to be considered based on wound location, depth, and patient’s medical co-morbidities, it is important to have a resource that can provide guidance on outcomes and complications for multiple microsurgical free tissue and flap options.