远端掌背侧皮瓣修复手指软组织缺损分为3类:掌背侧动脉穿支皮瓣,反向掌背动脉(RDMA)皮瓣,和延长反向掌背动脉(ERDMA)皮瓣。本系统综述旨在评估这三种皮瓣中常见缺陷和术后并发症的结果差异。
PubMed,Scopus,从首次报告公寓到2021年5月,对WebofScience进行了系统搜索。对每个结果进行随机效应荟萃分析,24项研究纳入分析.
掌背动脉穿支皮瓣主要用于延伸至指间关节近端(n=62[29.1%])和指骨近端(n=85[39.9%])的缺损。相反,延伸至远端指骨的缺损(n=24[43.6%])大部分是使用ERDMA皮瓣重建的。ERDMA皮瓣的静脉充血率最高(29.3%;95%置信区间[CI],-17.2%至65.1%;I2=0%),RDMA瓣最低(8.1%;95%CI,-5.9%至21.7%;I2=0%)。RDMA皮瓣显示任何短期并发症的发生率最低,包括部分和全部坏死(6.6%;95%CI,-6.8%至19.8%;I2=0%)。
这项系统评价表明,掌背动脉穿支皮瓣适用于中指骨近端重建。ERDMA皮瓣适用于远端指间关节远端重建。尽管RDMA皮瓣显示短期并发症发生率最低,并且有限的分析是有限的可用数据的次要原因,这些发生在远端掌骨背侧皮瓣的6.6%至10.9%。
Distally based dorsal metacarpal flaps for the reconstruction of finger soft-tissue defects are classified into 3 categories: dorsal metacarpal artery perforator flap, reverse dorsal metacarpal artery (RDMA) flap, and extended reverse dorsal metacarpal artery (ERDMA) flap. The present systematic
review aimed to evaluate differences in the outcomes of commonly encountered defects and postoperative complications among these three flaps.
PubMed, Scopus, and Web of Science were systematically searched from when the flats were first reported to May 2021. Random-effects meta-analysis for each outcome was performed, and 24 studies were included in the analysis.
Dorsal metacarpal artery perforator flaps were mainly used for defects extending to the proximal interphalangeal joint (n = 62 [29.1%]) and proximal phalanx (n = 85 [39.9%]). Conversely, defects extending to the distal phalanx (n = 24 [43.6%]) were mostly reconstructed using the ERDMA flap. The rate of venous congestion was highest for the ERDMA flap (29.3%; 95% confidence interval [CI], -17.2% to 65.1%; I2 = 0%) and lowest for RDMA flap (8.1%; 95% CI, -5.9% to 21.7%; I2 = 0%). The RDMA flap showed the lowest rate of any short-term complications, including partial and total necrosis (6.6%; 95% CI, -6.8% to 19.8%; I2 = 0%).
This systematic
review demonstrated that the dorsal metacarpal artery perforator flap was suitable for reconstruction proximal to the middle phalanx, and the ERDMA flap was suitable for reconstruction distal to the distal interphalangeal joint. Although the RDMA flap showed the lowest rate of short-term complications and limited analysis was secondary to limited data available, these occurred in 6.6% to 10.9% of distally based dorsal metacarpal flaps.