Background Free flaps for soft tissue coverage of the lower extremity can be broadly divided into muscle/musculocutaneous and fasciocutaneous flaps. The purpose of this systematic review and meta‐analysis was to assess their different post‐operative outcomes. Methods A systematic search was performed in PubMed, Scopus, and the Web of Science from their inception to February 2022. Non‐randomized comparative studies, which describe any post‐operative outcome of muscle/musculocutaneous and fasciocutaneous free flaps reconstruction in the lower extremity were included. Articles with duplicate titles, editorials, review articles, case series, case reports, and publications lacking an abstract, those reporting pediatric patients, those describing only muscle/musculocutaneous or fasciocutaneous free flaps, those with incomplete or incomparable post‐operative outcomes, and studies involving <10 muscle/musculocutaneous or fasciocutaneous free flaps were excluded. A comparative meta‐analysis was conducted on muscle/musculocutaneous and fasciocutaneous free flaps outcomes, comprising vascular thrombosis, partial or complete flap necrosis, infection, donor‐site complications, non‐union, and primary or recurrent osteomyelitis. The fixed‐effects meta‐analysis model was used when low heterogeneity (I2 < 50%) was identified. Results Twenty‐two articles with a total of 2711 flaps (1584 muscle/musculocutaneous flaps and 1127 fasciocutaneous flaps) were included in the qualitative and quantitative assessment. The rates of any flap necrosis (12.0% vs. 7.4%; p = 0.007) and donor‐site complications (16.7% vs. 6.7%; p < 0.0001) were significantly higher for muscle/musculocutaneous flaps than for fasciocutaneous flaps. There were no significant differences in the rates of vascular thrombosis (10.5% vs. 10.7%; p = 0.98), complete flap necrosis (6.2% vs. 4.7%; p = 0.30), infection (19.4% vs. 14.7%; p = 0.18), non‐union (18.9% vs. 14.8%; p = 0.33), and primary or recurrent osteomyelitis (14.7% vs. 12.4%; p = 0.69). Conclusion This meta‐analysis revealed no significant difference in long‐term post‐operative outcomes, but suggested that fasciocutaneous flaps should be preferred to avoid flap necrosis and donor‐site complications.
Background: Free flap surgeries are useful procedures for lower-extremity reconstruction. Recipient vein selection for anastomosis is important to avoid venous congestion and thrombosis. Although deep or superficial venous system can be used as a recipient vein site, there is a lack of consensus on which system would be superior to avoid postoperative complications. This systematic review and meta-analysis aimed to assess the differences in outcomes between deep and superficial vein anastomosis for lower-extremity free flap reconstruction. Methods:The PubMed, Scopus, Web of Science, and Cochrane Library medical databases were systematically searched from inception to April 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.A comparative meta-analysis was conducted on studies of deep and superficial venous system anastomosis outcomes, comprising vascular thrombosis, reoperation, complete flap necrosis, and any flap necrosis. The fixed-effects meta-analysis model was used when low heterogeneity (I 2 < 50%) was present.Results: Six studies with 789 flaps were included in the analysis and qualitative and quantitative syntheses. The rate of vascular thrombosis (8.2% vs. 15.1%; p = .005) was significantly lower for flaps involving deep vein anastomosis than for those involving superficial vein anastomosis. The rate of reoperation after deep vein anastomosis was lower than that after superficial vein anastomosis, with no statistically significant difference (9.0% vs. 14.7%; p = .06). There were no significant differences in the rates of complete (2.5% vs. 2.0%; p = .90) or any flap necrosis (7.0% vs. 9.8%; p = .20). Conclusion:Deep vein anastomosis might be recommended for avoiding vascular thrombosis.
Background Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). Methods PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. Results Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], −3.4–12.3%; I 2 = 0%), 21.8% overall complications (95% CI, 15.8–27.7%; I 2 = 0%), 8.0% limb loss (95% CI, 1.9–14.1%; I 2 = 0%), 15.4% graft loss (95% CI, 5.0–25.3%; I 2 = 37.9%), and 7.4% 30-day mortality (95% CI, −.9–15.6%; I 2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1–28.2%; I 2 = 0%), 23.2% (95% CI, 11.2–34.5%; I 2 = 10.2%), and 18.0% (95% CI, −3.537.8%; I 2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, −4.237.2%; I 2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI, .6–39.1%; I 2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, −6.1–16.6%; I 2 = 0%). Conclusions The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps.
No case of histopathologically confirmed delayed cerebral radiation necrosis (DCRN) that occurred twice at different regions and times in the same patient has been previously reported. We present a patient with such a rare clinical course and who is surviving long-term (over 13 years) with a history of a distant metastasis of a malignant tumour. To diagnose DCRN preoperatively was very difficult. However, surgical extirpation seemed to be effective for DCRN. The patient is still in a good performance status after surgery.
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