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J Reconstr Microsurg 2016; 32(05): 342-357
DOI: 10.1055/s-0036-1583301
Original Article: WSRM 2015 Scientific Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Donor-Site Morbidity Following Free Tissue Harvest from the Thigh: A Systematic Review and Pooled Analysis of Complications

Chrisovalantis Lakhiani
1   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Michael V. DeFazio
1   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Kevin Han
1   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Reuben Falola
1   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
,
Karen Evans
1   Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
Further Information

Publication History

19 October 2015

07 March 2016

Publication Date:
04 May 2016 (online)

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Abstract

Background Donor-site morbidity significantly influences patient satisfaction and quality of life following reconstructive surgery. The relevant donor-site morbidities associated with more commonly utilized thigh-based flaps are reviewed.

Methods A systematic search of the MEDLINE and Cochrane databases from 1994 to 2014 was conducted to identify all reports of “anterolateral thigh (ALT),” “vastus lateralis (VL),” “anteromedial thigh (AMT),” “transverse upper gracilis (TUG),” tensor fascia latae (TFL),” “gracilis,” and “rectus femoris (RF),” flaps. Only studies that investigated donor-site outcomes related to pain, paresthesia, wound dehiscence, infection, hematoma, seroma, contour deformity, and/or objective functional performance were included. Case series or anecdotal reports with less than five flaps, non-English, and animal studies were excluded.

Results A total of 116 articles representing 4,554 flaps were reviewed, including 2,922 ALT/VL, 148 AMT, 436 TUG, 278 TFL, 527 gracilis, and 243 RF flaps. The most frequently cited donor-site complication was paresthesia (range: 0–36.4%), followed by wound dehiscence (range: 0.9–8.3%), contour deformity (range: 0–5.2%), pain (range: 0–6.3%), and seroma (range: 0.4–2.0%). Despite mixed results regarding functional performance, pooled-analysis of dynamometric studies demonstrated a significant reduction in strength only after RF flap harvest (21%).

Conclusions Donor-site morbidity for thigh-flaps is minimal and appears to be well-tolerated by the majority of patients. Nevertheless, the appropriate flap selection is highly individualized, and patients must be informed of potential complications and morbidities specific to each flap. We have established the most current review of donor-site morbidity for thigh-based flaps to aid the surgeon in this important discussion.

Keywords

free flap - donor site - flap morbidity

Note

The authors have no financial disclosures to report.


 

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