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J Reconstr Microsurg 2023; 39(08): 581-588
DOI: 10.1055/a-2003-9004
Original Article

Combined Revascularization and Free Flap Reconstruction for Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis

Keisuke Shimbo 
1   Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
,
Haruka Kawamoto
1   Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
,
Isao Koshima
2   Department of Plastic and Reconstructive Surgery, Hiroshima University Hospital, Hiroshima, Japan
3   International Center for Lymphedema, Hiroshima University Hospital, Hiroshima, Japan
› Author Affiliations Funding None.
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Abstract

Background Combined revascularization and free flap reconstruction is one treatment method for chronic limb-threatening ischemia (CLTI) with complex wounds. The purpose of this systematic review and meta-analysis was to investigate the characteristics of this combined procedure and to assess postoperative outcomes.

Methods A systematic search was performed across PubMed, Scopus, and the Web of Science for studies between January 2000 and February 2022. A random-effects meta-analysis for postoperative outcome was conducted.

Results Fifteen articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment. Our meta-analysis showed the following complication rates for short-term postoperative outcomes: 37% (95% confidence interval [CI], 18–53%; I 2 = 74%) for reoperation, 13% (95% CI, 2–24%; I 2 = 0%) for vascular thrombosis, 9% (95% CI, 0–17%; I 2 = 0%) for total flap failure, 8% (95% CI, 0–17%; I 2 = 0%) for partial flap failure, 4% (95% CI, 0–10%; I 2 = 0%) for amputation, and 3% (95% CI, 0–9%; I 2 = 0%) for 30-day mortality. The 1-, 3-, and 5-year limb salvage rates were 86% (95% CI, 78–92%), 81% (95% CI, 68–88%), and 71% (95% CI, 53–83%), respectively. The 1-, 3-, and 5-year patient survival rates were 93% (95% CI, 90–96%), 92% (95% CI, 77–97%), and 75% (95% CI, 50–88%), respectively.

Conclusion Combined revascularization and free flap reconstruction for CLTI with complex wounds was clearly effective for the long-term outcomes. However, this combined procedure should be considered on the assumption that the reoperation rate is high and that flap-related complications rate may be higher than lower extremity reconstruction of other etiologies.

Keywords

chronic limb-threatening ischemia - peripheral artery disease - endovascular revascularization - bypass - free flap


Publication History

Received: 24 June 2022

Accepted: 30 November 2022

Accepted Manuscript online:
28 December 2022

Article published online:
19 January 2023

© 2023. Thieme. All rights reserved.

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