首页|Outcomes of microsurgical free tissue transfer performed on international surgical collaborations in low-income and middle-income countries: A systematic review and meta-analysis

Outcomes of microsurgical free tissue transfer performed on international surgical collaborations in low-income and middle-income countries: A systematic review and meta-analysis

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  • NSTL
  • Elsevier
? 2022Background: Microsurgical free tissue transfer is the gold standard for reconstruction of significant soft tissue and bony defects following cancer resection and trauma. Many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources or training required to perform microsurgical procedures. Long-term international collaborations have been formed with annual reconstructive programmes conducting microsurgery. Aims: To critically analyze outcomes of microsurgical free tissue transfer performed on international reconstructive collaborations in LMICs. Methods: PRISMA-compliant systematic review and meta-analysis of outcomes for free tissue transfer performed during international collaborations in LMICs using an inverse variance model. The study protocol was published prospectively and registered with PROSPERO (ID: CRD42021225613). Results: Seven studies, included 290 flaps on 284 patients. The most common sites requiring reconstruction were Head and neck (53% (n = 153)) and lower limb (7.9% (n = 23)) were lower limb reconstruction. The most common free flaps were radial forearm (22%; n = 64) and anterolateral thigh (18%; n = 51). Total Flap Failure rate was 3.8% (n = 13; 95% confidence interval (CI) = 1.9–6.3%) Overall complication rate was 38% (95% CI =27–48%), with 19% of flaps requiring emergency return to theatre (95% CI =14–26%). Flap salvage was successful in 52% of take-backs (95% CI =15% - 88%). Conclusions: Free flaps performed during international surgical collaborations in LMICs have comparable failure rates to those performed in higher-income settings. However, there are higher complication and take-back rates. This should be taken into account when planning international collaborations. These results should help preoperative counselling and the consent process.

Free flapFree tissue transferInternational surgical collaborationsLow-income and middle-income countriesMicrosurgerySurgical missions

de Berker H.T.、Cebron U.、Bradley D.、Patel V.、Berhane M.、Almas F.、Walton G.、Eshete M.、McGurk M.、Martin D.、Honeyman C.

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Department of Plastic Surgery Royal Preston Hospital

Department of Hand Plastic Reconstructive and Burn Surgery University of Tübingen

King's College London Faculty of Dentistry Oral and Craniofacial Sciences Guy's Tower Guy's Hospital

Oral Surgery Department Guy's Dental Institute Guy's & St Thomas’ NHS Foundation Trust

Department of Plastic and Reconstructive Surgery ALERT Hospital

Department of Cranio-Maxillofacial and Reconstructive Surgery Saint Judes General Hospital Federal

Department of Head and Neck Surgery University Hospitals Coventry and Warwickshire

Department of Surgery School of Medicine College of Health Sciences Addis Ababa University

Department of Head and Neck Surgery University College London Hospital

Private Practice

Canniesburn Plastic Surgery and Burns Unit

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2022

10.1016/j.bjps.2022.04.002

Journal of plastic, reconstructive & aesthetic surgery

Journal of plastic, reconstructive & aesthetic surgery

ISSN：1748-6815
年,卷(期)：2022.75(7)
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