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Soft tissue reconstruction of combat-related injuries in the upper limb—should serial debridement’s be prioritised over time to reconstruction? A systematic review and meta-analysis

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Abstract

Background

Major extremity trauma forms a considerable proportion of CRI. The aim of this study was to determine whether time to reconstruction and number of debridement’s had an impact on flap success in upper limb CRI.

Methods

A literature search was conducted on Pubmed, Dynamed, DARE, EMBASE, Cochrane, TRIP, Google scholar 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

Eight articles met the inclusion criteria, covering 65 patients and 74 flaps. Flap success rate was 93% (95% CI: 0.87 – 0.98) with an overall flap complication rate of 10.3% (95% CI 3.4% - 17.2%, p=0.02). Successful flaps had a mean of 8.3 (SD 4.76) pre-flap debridement’s versus 5.7 (SD 2.16) debridement’s in failed flaps.

Conclusions

Soft-tissue reconstruction in CRI often faces complexities due to associated injuries and the risk of infection. Whilst timely reconstruction is important, prioritizing meticulous and often multiple debridement’s over time targets may aid in flap success.

Level of evidence

Level III, Therapeutic.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK

    Elena Whiteman & Umar Rehman

  2. Morriston Hospital, Swansea, Wales, UK

    Hamza Ejaz

  3. Department of Plastic Surgery, Lister Hospital, Stevenage, UK

    Manaf Khatib

  4. Department of Plastic Surgery, St Thomas’ Hospital, London, UK

    Naveen Cavale

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  1. Elena Whiteman
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Contributions

All authors contributed to the study conception and design. EW and HE contributed equally to the paper and are joint first authors. EW contributed to the conception/design/literature search and final manuscript writing. HE contributed to the conception/design/literature search/statistical analysis and final manuscript writing. UR contributed to the conception/study design/literature search and final manuscript writing. MK contributed to the conception/study design and final manuscript writing. NC contributed to the conception/study design and final manuscript writing.

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Correspondence to Elena Whiteman.

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Elena Whiteman, Hamza Ejaz, Umar Rehman, Manaf Khatib, and Naveen Cavale declare no conflict of interest.

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Whiteman, E., Ejaz, H., Rehman, U. et al. Soft tissue reconstruction of combat-related injuries in the upper limb—should serial debridement’s be prioritised over time to reconstruction? A systematic review and meta-analysis. Eur J Plast Surg 46, 887–900 (2023). https://doi.org/10.1007/s00238-023-02136-3

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