Free Flap Reconstruction of Abdominal Wall Defects: A Systematic Review and Pooled Analysis

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2025-04-07 DOI:10.1002/micr.70059

Michael I. Kim, Artur Manasyan, Eloise W. Stanton, Christian Jimenez, Joseph N. Carey, David A. Daar, Emma C. Koesters

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引用次数: 0

Abstract

Background

Reconstruction of extensive abdominal wall defects poses significant challenges, often requiring free tissue transfer when traditional methods are inadequate. This review examines the past decade's literature on free flaps for abdominal wall reconstruction to guide decision-making.

Methods

A systematic review following PRISMA guidelines was conducted on July 17, 2024, using PubMed, Cochrane Library, Web of Science, Embase, and Scopus. Studies from 2013 to 2023 involving free flap reconstruction with at least 3 months follow-up were included. Surgical complications and outcomes were analyzed.

Results

Of 2269 articles, 32 met inclusion criteria, involving 104 free flaps. There were no reports of flap loss. The average defect size was 330.0 ± 200.8 cm². Oncologic resection was the leading indication (57%), with the latissimus dorsi flap used most frequently (36%). The most common recipient vessels were the deep inferior epigastric vessels (66.7%). The most common recipient vessels were the deep inferior epigastric vessels (66.7%). Mesh was used in 53% of cases, predominantly in a sublay position. The majority of reconstructions were immediate (52.9%), followed by delayed (31.8%) and staged (15.3%). Complications included partial flap necrosis (5.8%), surgical site infection (5.8%), and hernia development (4.8%). There were no significant differences in outcomes when stratified by reconstruction timing, flap choice, recipient vessels, or mesh characteristics. Infection as the defect etiology independently predicted surgical site infection (p = 0.03), whereas mesh usage (p = 0.07) and diabetes (p = 0.09) trended toward increased infection risk. Donor site complications were minimal.

Conclusion

Free flap reconstruction is safe and effective for large abdominal wall defects, with similar outcomes across flap types. Infection as the initial etiology was the strongest predictor of postoperative infection. Further studies are needed to establish guidelines for patient and flap selection.

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游离皮瓣重建腹壁缺损：系统回顾和汇总分析

背景广泛腹壁缺损的重建面临着巨大的挑战，通常需要在传统方法不充分的情况下进行自由组织移植。本文回顾了过去十年关于腹壁重建游离皮瓣的文献，以指导决策。方法于2024年7月17日采用PubMed、Cochrane Library、Web of Science、Embase、Scopus等数据库，按照PRISMA指南进行系统评价。纳入2013年至2023年涉及游离皮瓣重建且随访至少3个月的研究。分析手术并发症及结果。结果2269篇文献中，32篇符合纳入标准，涉及游离皮瓣104个。没有皮瓣丢失的报告。平均缺陷尺寸为330.0±200.8 cm2。肿瘤切除是主要适应症（57%），背阔肌皮瓣使用最多（36%）。最常见的受体血管为上腹部深下血管（66.7%）。最常见的受体血管为上腹部深下血管（66.7%）。53%的病例使用补片，主要是在地下位置。大多数是立即重建（52.9%），其次是延迟重建（31.8%）和分期重建（15.3%）。并发症包括部分皮瓣坏死（5.8%）、手术部位感染（5.8%）和疝发展（4.8%）。根据重建时间、皮瓣选择、受体血管或网状物特征进行分层时，结果无显著差异。感染作为缺陷病因独立预测手术部位感染（p = 0.03），而补片使用（p = 0.07）和糖尿病（p = 0.09）倾向于增加感染风险。供体部位并发症极少。结论游离皮瓣修复大面积腹壁缺损是安全有效的，不同类型的皮瓣修复效果相近。感染作为初始病因是术后感染的最强预测因子。需要进一步的研究来建立患者和皮瓣选择的指导方针。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.