PMID- 36577499
OWN - NLM
STAT- MEDLINE
DCOM- 20230915
LR  - 20230915
IS  - 1098-8947 (Electronic)
IS  - 0743-684X (Linking)
VI  - 39
IP  - 8
DP  - 2023 Oct
TI  - Combined Revascularization and Free Flap Reconstruction for Chronic 
      Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis.
PG  - 581-588
LID - 10.1055/a-2003-9004 [doi]
AB  - 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.
CI  - Thieme. All rights reserved.
FAU - Shimbo, Keisuke
AU  - Shimbo K
AUID- ORCID: 0000-0003-0761-4147
AD  - Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, 
      Hiroshima, Japan.
FAU - Kawamoto, Haruka
AU  - Kawamoto H
AD  - Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, 
      Hiroshima, Japan.
FAU - Koshima, Isao
AU  - Koshima I
AD  - Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, 
      Hiroshima, Japan.
AD  - International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, 
      Japan.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20221228
PL  - United States
TA  - J Reconstr Microsurg
JT  - Journal of reconstructive microsurgery
JID - 8502670
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - *Free Tissue Flaps/surgery
MH  - Risk Factors
MH  - Treatment Outcome
MH  - *Peripheral Arterial Disease
MH  - Ischemia/surgery
MH  - Limb Salvage/methods
MH  - Retrospective Studies
COIS- None declared.
EDAT- 2022/12/29 06:00
MHDA- 2023/09/15 06:42
CRDT- 2022/12/28 19:12
PHST- 2023/09/15 06:42 [medline]
PHST- 2022/12/29 06:00 [pubmed]
PHST- 2022/12/28 19:12 [entrez]
AID - 10.1055/a-2003-9004 [doi]
PST - ppublish
SO  - J Reconstr Microsurg. 2023 Oct;39(8):581-588. doi: 10.1055/a-2003-9004. Epub 2022 
      Dec 28.