Abstract
Background
Major extremity trauma forms a considerable proportion of combat-related injuries. Coverage of lower limb soft tissue defects utilises the reconstructive ladder. The 72-h target to definitive reconstruction has been proposed in civilian trauma. The primary aim of this study was to determine whether the time to definitive reconstruction and the number of pre-flap debridements have an impact on flap success in lower limb combat injury reconstructions.
Methods
A literature search was conducted on Pubmed, Prospero, Dynamed, DARE, EMBASE, COCHRANE and BMJ databases. A random effects model was used due to significant heterogeneity between the papers and a meta-regression was implemented for the analysis of outcomes.
Results
A total of seven studies had fulfilled the inclusion criteria. The cumulative number of flaps performed was 378 (255 free flaps and 123 non-free flaps). The Latissimus Dorsi free flap was the most common flap performed (n = 153). The proportion of flap success across the studies was 88% (0.88, 95% CI: 0.77–0.94). There was no statistically significant impact of the number of pre-flap debridements on flap success rates (OR of: 1.23 [95% CI: 0.62 to 2.44], p > 0.05). Time to reconstruction had no statistically significant impact on flap success rates (OR of: 0.88 [95% CI: 0.77 to 1.00], p > 0.05).
Conclusions
The choice of flap used in lower limb combat-related injuries is dependent upon the type, extent and location of injury. Onus should be placed on ensuring the wound is adequately debrided prior to definitive coverage to provide a healthy wound bed for reconstruction.
Level of Evidence: Not gradable
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Abbreviations
- AHRQ:
-
The Agency for Healthcare Research and Quality
- ALT:
-
Anterolateral thigh
- CRI:
-
Combat-related injuries
- ETFL:
-
Extensor tensor fascia latae
- ICRC:
-
International Committee of the Red Cross
- LD:
-
Latissimus dorsi
- LL:
-
Lower limb
- RA:
-
Rectus abdominis
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Umar Rehman, Elaine Cole, Elena Whiteman, Manaf Khatib, Naveen Cavale and Christos Giannou declare no competing interests.
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Rehman, U., Cole, E., Whiteman, E. et al. Soft tissue reconstruction of combat-related injuries affecting the lower limb: is a time target realistic? A systematic review and meta-analysis. Eur J Plast Surg 46, 935–946 (2023). https://doi.org/10.1007/s00238-023-02095-9
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DOI: https://doi.org/10.1007/s00238-023-02095-9