Upper and lower Free Flap Revision Procedures: A Systematic Review and meta-analysis
Poster #: 037
Session/Time: B
Author:
Adam Nasser Akari, BS, MS
Mentor:
Manas Nigam, MD
Research Type: Review Article
Abstract
INTRODUCTION:
Free flap reconstruction is widely considered the gold standard for managing complex soft tissue defects requiring durable coverage. Fasciocutaneous and myocutaneous flaps often undergo secondary procedures such as direct excision, suction lipectomy, or skin grafting to improve contour and achieve better size match with the contralateral extremity. This is the first systematic review and meta-analysis evaluating the indications, timing, complication rates, and quantity of secondary debulking procedures in extremity free flap reconstruction.
MAIN BODY:
This PRISMA-compliant systematic review and meta-analysis included studies from four databases and is registered with PROSPERO (CRD420251076748). Retrospective and prospective studies that specifically evaluated secondary debulking, contouring, thinning, or aesthetic refinement of free flaps for upper and lower extremity reconstruction were included. Studies focused on primary thinning or debulking, or those reporting fewer than 10 revised flaps, were excluded. Extracted data included demographics, the average number of revisions per free flap, the percentage of patients with revised flaps, and the number of revision procedures per revised flap. Meta-analyses were performed using a random effects model.
RESULTS:
A total of 26 retrospective studies and one prospective study were included, encompassing 3,887 patients and 3,751 free flaps. The mean ages in the upper extremity (UE) and lower extremity (LE) cohorts were 33.93 ± 11.06 years and 45.96 ± 15.01 years, respectively. Meta-analyses found that 46% ± 40% (I² = 0%) of UE flaps and 16% ± 8% (I² = 0%) of LE flaps underwent a revision procedure. On average, 0.48 and 0.17 revision procedures were performed per free flap in the UE and LE cohorts, respectively. Among revised flaps, 1.04 procedures were performed per flap in the UE cohort and 0.23 in the LE cohort.
CONCLUSION:
Meta-analysis findings show that secondary debulking procedures are commonly performed following free flap reconstruction, with higher revision rates in the upper extremity and higher complication rates in the lower extremity. Future research should investigate factors contributing to these regional differences and strategies to reduce complications.
Free flap reconstruction is widely considered the gold standard for managing complex soft tissue defects requiring durable coverage. Fasciocutaneous and myocutaneous flaps often undergo secondary procedures such as direct excision, suction lipectomy, or skin grafting to improve contour and achieve better size match with the contralateral extremity. This is the first systematic review and meta-analysis evaluating the indications, timing, complication rates, and quantity of secondary debulking procedures in extremity free flap reconstruction.
MAIN BODY:
This PRISMA-compliant systematic review and meta-analysis included studies from four databases and is registered with PROSPERO (CRD420251076748). Retrospective and prospective studies that specifically evaluated secondary debulking, contouring, thinning, or aesthetic refinement of free flaps for upper and lower extremity reconstruction were included. Studies focused on primary thinning or debulking, or those reporting fewer than 10 revised flaps, were excluded. Extracted data included demographics, the average number of revisions per free flap, the percentage of patients with revised flaps, and the number of revision procedures per revised flap. Meta-analyses were performed using a random effects model.
RESULTS:
A total of 26 retrospective studies and one prospective study were included, encompassing 3,887 patients and 3,751 free flaps. The mean ages in the upper extremity (UE) and lower extremity (LE) cohorts were 33.93 ± 11.06 years and 45.96 ± 15.01 years, respectively. Meta-analyses found that 46% ± 40% (I² = 0%) of UE flaps and 16% ± 8% (I² = 0%) of LE flaps underwent a revision procedure. On average, 0.48 and 0.17 revision procedures were performed per free flap in the UE and LE cohorts, respectively. Among revised flaps, 1.04 procedures were performed per flap in the UE cohort and 0.23 in the LE cohort.
CONCLUSION:
Meta-analysis findings show that secondary debulking procedures are commonly performed following free flap reconstruction, with higher revision rates in the upper extremity and higher complication rates in the lower extremity. Future research should investigate factors contributing to these regional differences and strategies to reduce complications.