Free flaps for reconstruction of soft tissue defects in lower extremity: A meta‐analysis on microsurgical outcome and safety

Background Microsurgical free flaps for reconstruction of soft tissue defects in lower extremity have evolved into a reliable procedure over last decades; however, there lacked high level of evidence. Methods A systematic literature research was performed including studies between 2000 and 2014 in English, German, and Chinese (PubMed, EMBASE). Publications were selected applying inclusion/exclusion criteria. Postoperative complications were statistically analyzed with metaprop command of R GUI 3.0.1. Results Alltogether 30 articles overlooking 1,397 free flaps were included. The rate of total flap loss was 6.0% (95% confidence interval [CI] = 4.0%–8.0%, P Q ( P values of Q statistics) = 0.03); the thrombosis rate was 6.0% (95% CI = 4.0%–9.0%, P Q  = 0.01); the hematoma rate was 4.0% (95% CI = 3.0%–5.0%, P Q  = 0.79); the partial necrosis rate was 6.0% (95% CI = 4.0%–10.0%, P Q  < 0.01); the early infection rate was 4.0% (95% CI = 2.0%–6.0%, P Q  = 0.03), and the dehiscence rate was 3.0% (95% CI = 2.0%–5.0%, P Q  = 0.12). Reconstruction for diabetic foot may be not associated with a significant increase of procedural risk (Total flap loss rate = 6%, 95% CI = 3.0%–9.0%, P Q  = 0.44). Conclusions Microsurgical reconstruction of soft tissue defects in the lower extremity reconstruction could be regarded safe and reliable. A standardization of report of perioperative parameters and clinical outcomes is needed. © 2016 Wiley Periodicals, Inc. Microsurgery 36:511–524, 2016.