title: Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety.
abstract: BACKGROUND
  Microsurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence.
  
  
  METHODS
  A systematic literature research was performed including studies between 2000 and 2014 in English, German, and Chinese (PubMed, EMBASE). Publications were selected applying inclusion/exclusion criteria. Postoperative complications were statistically analyzed with metaprop command of R GUI 3.0.1.
  
  
  RESULTS
  Alltogether 30 articles overlooking 1,397 free flaps were included. The rate of total flap loss was 6.0% (95% confidence interval [CI] = 4.0%-8.0%, PQ (P values of Q statistics) = 0.03); the thrombosis rate was 6.0% (95% CI = 4.0%-9.0%, PQ  = 0.01); the hematoma rate was 4.0% (95% CI = 3.0%-5.0%, PQ  = 0.79); the partial necrosis rate was 6.0% (95% CI = 4.0%-10.0%, PQ  < 0.01); the early infection rate was 4.0% (95% CI = 2.0%-6.0%, PQ  = 0.03), and the dehiscence rate was 3.0% (95% CI = 2.0%-5.0%, PQ  = 0.12). Reconstruction for diabetic foot may be not associated with a significant increase of procedural risk (Total flap loss rate = 6%, 95% CI = 3.0%-9.0%, PQ  = 0.44).
  
  
  CONCLUSIONS
  Microsurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. © 2016 Wiley Periodicals, Inc. Microsurgery 36:511-524, 2016.
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.|Department of Plastic and Reconstructive Surgery, Aesthetic Surgery Center, Union Hospital, Huazhong University of Science and Technology, 430022, Wuhan, P.R. China.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.
authors.forename: Emre
authors.initials: E
authors.lastname: Gazyakan
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kremer
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Hernekamp
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Harhaus
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, 55905.
authors.forename: Michel
authors.initials: M
authors.lastname: Saint-Cyr
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, 67071, Germany. christoph.hirche@bgu-ludwigshafen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hirche
mesh_terms: D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods*