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Duan A, Xiang Z, Fan Y, Duan W, Wei Q, Duan X. Evaluating the clinical efficacy of the anterolateral thigh flap in lower limb reconstruction surgeries: a systematic review and meta-analysis. Am J Transl Res 2024; 16:3326-3337. [PMID: 39114696 PMCID: PMC11301478 DOI: 10.62347/hfve6316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/01/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To comprehensively assess the clinical efficacy of the anterolateral thigh flap in lower limb reconstruction (LLR) surgeries and explore its application value via a meta-analysis. METHODS Published articles on the efficacy of anterolateral thigh flap in LLR were retrieved in English databases such as PubMed, Web of Science, Embase, and The Cochrane Library, which were searched from their inception to November 2023. The search terms included "anterolateral thigh flaps", "lower extremity", "free muscle" and "reconstruction". Subsequently, data extraction of eligible studies was carried out, and data analysis was conducted using RevMan 5.3 software. RESULTS The final selection comprised 12 appropriate studies, encompassing a total of 577 patients. Meta-analysis demonstrated that negligible differences existed in the length of hospital stay among patients treated with different types of flaps (mean difference (MD) =-0.10, 95% confidence interval (CI) =-0.400.20, P>0.05). Additionally, the occurrence of complications differed slightly (Risk difference (RD) =-0.02, 95% CI=-0.090.05, P>0.05). The incidence of secondary surgeries also demonstrated non-significant differences (RD=-0.04, 95% CI=-0.11-0.04, P>0.05). Nevertheless, patients who underwent anterolateral thigh flap transplantation exhibited a drastic decrease in donor site morbidity (Odds ratio (OR) =0.22, 95% CI=0.10-0.49, P<0.05). CONCLUSION The clinical efficacy of the anterolateral thigh flap in LLR surgeries shows no significant differences in hospital stay, complication rates, or the need for secondary surgeries compared to other flaps. However, using anterolateral thigh flap in LLR significantly reduces donor site morbidity.
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Affiliation(s)
- Alin Duan
- Department of Orthopedics, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
- Department of Restoration and Reconstruction, No. 1 Orthopedics Hospital of ChengduChengdu 610041, Sichuan, China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
| | - Yongxi Fan
- Department of Restoration and Reconstruction, No. 1 Orthopedics Hospital of ChengduChengdu 610041, Sichuan, China
| | - Weinan Duan
- Department of Restoration and Reconstruction, No. 1 Orthopedics Hospital of ChengduChengdu 610041, Sichuan, China
| | - Qingyu Wei
- Department of Restoration and Reconstruction, No. 1 Orthopedics Hospital of ChengduChengdu 610041, Sichuan, China
| | - Xin Duan
- Department of Orthopedics, West China Hospital of Sichuan UniversityChengdu 610041, Sichuan, China
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Crenn V, Quinette Y, Bouthors C, Missenard G, Viard B, Anract P, Boisgard S, Mascard E, Gouin F. Intercalary allograft reconstruction following femoral tumour resection: mid- and long-term results and benefits of adding a vascularised fibula autograft. World J Surg Oncol 2022; 20:195. [PMID: 35698130 PMCID: PMC9195446 DOI: 10.1186/s12957-022-02650-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Bone healing in femoral reconstructions using intercalary allografts can be compromised in a tumour context. There is also a high revision rate for non-union, infection, and fractures in this context. The advantages and disadvantages of an associated vascularised fibula graft (VFG) are still a matter of debate. Methods In a multicentre study, we retrospectively analysed 46 allograft reconstructions, operated on between 1984 and 2017, of which 18 were associated with a VFG (VFG+) and 28 without (VFG−), with a minimum follow-up of 2 years. We determined the cumulative probability of bone union as well as the mid- and long-term revision risks for both categories by Kaplan-Meier survival analysis and a multivariate Cox model. We also compared the MSTS scores. Results Significant differences in favour of VFG+ reconstruction were observed in the survival analyses for the probability of bone union (log-rank, p = 0.017) and in mid- and long-term revisions (log-rank, p = 0.032). No significant difference was observed for the MSTS, with a mean MSTS of 27.6 in our overall cohort (p = 0.060). The multivariate Cox model confirmed that VFG+ was the main positive factor for bone union, and it identified irradiated allografts as a major risk factor for the occurrence of mid- and long-term revisions. Conclusion Bone union was achieved earlier in both survival and Cox model analyses for the VFG+ group. It also reduced the mid- and long-term revision risk, except when an irradiated allograft was used. In case of a tumour, we thus recommend using VFG+ from a fresh-frozen allograft, as it appears to be a more reliable long-term option. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02650-x.
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Affiliation(s)
- Vincent Crenn
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France. .,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.
| | - Yonis Quinette
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France
| | - Charlie Bouthors
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Gilles Missenard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Brice Viard
- Service de Chirurgie Orthopédique, APHP/CHU Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique, AP-HP/Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Stéphane Boisgard
- Service de Chirurgie Orthopédique, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Eric Mascard
- Département de Chirurgie Orthopédique Pédiatrique, APHP/Hôpital Necker, 149 rue de Sèvres, 75015, Paris, France
| | - François Gouin
- Service de Chirurgie Orthopédique, CHU de Nantes, Place Alexis Ricordeau, 44000, Nantes, France.,INSERM, UMR 1238, Phy-Os, Université de Nantes, Nantes, France.,Département de Chirurgie, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
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Ferry AM, Gimenez AR, Abu-Ghname A, Xue EY, Pederson WC, Lazo DÁA, Maricevich M. Reconstruction of Complex Lower Extremity Defects. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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