Outcomes of Microsurgical Reconstruction of Post-Burn Joint Contracture—Systematic Review and Meta-Analysis

IF 1.7 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2025-08-15 DOI:10.1002/micr.70104

Abdulaziz Elemosho, Layne N. Raborn Macdonald, Derek E. Bell, Jeffrey E. Janis

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Abstract

Background

Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction.

Methods

A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model.

Results

Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (I² = 0% [95% CI: 97.7–99.6]) of pedicled and 90.1% (I² = 82.8% [95% CI: 62.7–100]) of free flap reconstructions, recurring in 1.8% (I² = 0% [95% CI: 0.7–3.3]) at sites reconstructed with pedicled flaps and 0.6% (I² = 0% [95% CI: 0.1–1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (I² = 0% [95% CI: 0.6–2.7]) and 2.9% (I² = 37.9% [95% CI: 0.9–5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (I² = 65.1% [95% CI: 3.4–11.5]) and 5.2% (I² = 65% [95% CI: 1.7–10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (p = 0.50), contracture recurrence (p = 0.15), total flap loss (p = 0.18) or partial flap loss (p = 0.31) regardless of the flap type used.

Conclusions

Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.

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烧伤后关节挛缩显微外科重建的疗效：系统回顾和荟萃分析

背景：挛缩复发是烧伤重建常见的挫折，特别是对于严重或大面积挛缩。以皮瓣为基础的烧伤重建已显示出较低的挛缩复发率。本研究旨在总结和评估基于皮瓣的技术用于烧伤后关节挛缩重建的结果。方法按照PRISMA指南进行系统评价。检索的数据库包括PUBMED、EMBASE、Scopus和Web of Science。文章描述了使用具有已知血液供应的皮瓣重建烧伤后关节挛缩。排除资料不完整、涉及多个解剖部位挛缩、病例报告和非英文文章的研究。提取患者人口统计学、皮瓣类型、并发症和挛缩消退的数据。采用DerSimonian和Laird随机效应模型进行比例荟萃分析。结果在850项研究中，27项符合纳入标准。报告830例关节挛缩重建。带蒂皮瓣重建的挛缩消退率为98.9% (I2 = 0% [95% CI: 97.7-99.6])，自由皮瓣重建的挛缩消退率为90.1% (I2 = 82.8% [95% CI: 62.7-100])，带蒂皮瓣重建的部位复发率为1.8% (I2 = 0% [95% CI: 0.7-3.3])，自由皮瓣重建的部位复发率为0.6% （I2 = 0% [95% CI: 0.1-1.7]）。皮瓣并发症发生率较低，有蒂皮瓣和自由皮瓣的总皮瓣损失分别为1.5% （I2 = 0% [95% CI: 0.6-2.7]）和2.9% （I2 = 37.9% [95% CI: 0.9-5.8]）。带蒂皮瓣和自由皮瓣的部分皮瓣损失分别为6.9% （I2 = 65.1% [95% CI: 3.4-11.5]）和5.2% （I2 = 65% [95% CI: 1.7-10.4]）。无论使用何种皮瓣，在挛缩消退率（p = 0.50）、挛缩复发率（p = 0.15）、皮瓣全损率（p = 0.18）或部分皮瓣损率（p = 0.31）方面均无显著差异。结论皮瓣重建烧伤挛缩并发症少，挛缩复发率低。带蒂和自由皮瓣重建烧伤挛缩部位产生相似的结果。

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.