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Outcomes of Muscle versus Fasciocutaneous Free Flap Reconstruction in Acute Burn Injuries: A Systematic Review and Meta-analysis
José Antonio Arellano, MD; Mario Alessandri-Bonetti, MD; Hilary Y Liu, BS; Sumaarg Pandya, BS; Francesco M Egro, MD, MSc, MRCS.
University of Pittsburgh
2024-01-15
Presenter: Jose Antonio Arellano
Affidavit:
Dr. Peter Rubin
Director Name: Dr. Peter Rubin
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Free flap reconstruction in acute burns is high risk but often required for limb salvage and coverage of vital structures. Prior studies have demonstrated a flap loss rate as high as 40%. To identify ways to mitigate this high flap loss rate, this study aimed to compare the complications associated with muscle and fasciocutaneous free flaps in acute burn reconstruction.
Methods: A systematic review and meta-analysis was reported according to PRISMA guidelines and registered on the PROSPERO database (CDR42023471088). The following databases were accessed: Embase, PubMed, Web of Science, and Cochrane Library. The primary outcome was the free flap failure rate based on the flap type employed for reconstruction.
Results: Twelve studies accounting for 181 free flaps were included: 87 muscle flaps and 94 fasciocutaneous flaps. Muscle flaps were found to have a higher risk ratio for total flap loss (RR: 2.32, 95% CI: 1.01–5.32, p=0.04), arterial thrombosis (RR: 3.13, 95% CI: 1.17–8.42, p=0.02) and amputations (RR: 8.89, 95% CI: 1.27-70.13, p=0.03) when compared to fasciocutaneous flaps. However, no significant differences were found in venous thrombosis (RR: 1.33, 95% CI: 0.37–4.78, p=0.65) or need for re-interventions (RR: 1.34, 95% CI: 0.77-2.32, p=0.29).
Conclusions: The use of muscle flaps in burn injuries is associated with a higher risk of flap failure, arterial thrombosis, and amputations. The use of fasciocutanoues free flaps in acute burns appears to be safer and lead to better outcomes, although further research is needed to confirm these findings.
