<< Back to the abstract archive
Impact of Microsurgical Reconstruction Timing on the Risk of Free Flap Loss in Acute Burns: A Systematic Review and Meta-Analysis
Jose Antonio Arellano, MD1; Mario Alessandri-Bonetti, MD1; Julia A Kasmirski, MS1; Hilary Liu, MS1; Jenny A Ziembicki, MD2; Guy M Stofman, MD1; Francesco M Egro, MBChB, MRCS, MSc1, 2.
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
Background
Free tissue transfer is usually considered as a last resort in severe burn cases, when local flaps are not viable options. Prior studies have demonstrated a free flap loss rate ranging from 0 to 44%. The aim of this study is to identify ideal timing to perform free flap reconstruction in acute burn-related injuries in order to minimize free flap loss.
Methods
This systematic review was reported according to PRISMA guidelines. PubMed/MEDLINE, Embase, Web Of Science and Cochrane Library databases were queried. The review protocol was registered on PROSPERO database (CRD42023404478). Three time intervals from day of injury were identified: (1) <5 days, (2) 5-21 days, (3) 22 days-6 weeks. The primary outcome was complete free flap loss.
Results
A total of 17 articles met inclusion criteria. The analysis included 275 free flaps performed in 260 patients (88% male, 12% females) affected by acute burn injuries. The meta-analysis of proportions including all free flap reconstructions in all time intervals showed a pooled prevalence of 11.64 % [95% CI: 8.35% - 15.99%] of complete free flap loss in acute burns. The pooled prevalence of free flap failure in the three time intervals (<5 days, 5-21 days, 22 days-6 weeks) were 7.32 % [95% CI: 2.38% - 20.37%], 15.75% [95% CI: 10.70% - 22.59%], 6.82% [95% CI: 3.10% - 14.36%], respectively.
Conclusion
free flap reconstruction in acute burn patients poses a high risk of failure. The timing of the reconstruction significantly influences surgical outcomes, higher flap loss rates observed when performed between day 5 and day 21 from the burn injury.
