Flap coverage for necrotising soft tissue infections: A systematic review

Area of Science:

• Plastic Surgery
• Wound Healing
• Infectious Diseases

Background:

• Necrotising soft tissue infections (NSTI) are severe, life-threatening conditions requiring urgent treatment.
• Surgical reconstruction after debridement aims to minimize patient disability and optimize appearance.
• While skin grafting is an option, advanced reconstructive techniques like flaps are sometimes necessary.

Purpose of the Study:

• To systematically review the use of flaps in managing NSTI.
• To identify circumstances favoring flap use over other methods.
• To determine common flap types and anatomical locations for NSTI reconstruction.

Main Methods:

• A systematic literature review was performed using Medline, Embase, and Cochrane Library.
• Full-text articles detailing flap use for NSTI (including Necrotising Fasciitis and Fournier Gangrene) were included.
• Data on patient numbers, anatomical areas, flap types, and complications were extracted and managed using 'Covidence'.

Main Results:

• Out of 4555 references, 230 manuscripts reported 888 flap closures in 733 patients with NSTI.
• Perineal reconstruction for Fournier's gangrene constituted the majority (58.6%) of flap uses.
• Loco-regional fasciocutaneous flaps (71%) were most frequent, followed by loco-regional muscle flaps (18%), with free flaps used infrequently (8%). The overall flap loss rate was 3.3%.

Conclusions:

• Flaps offer a durable and effective solution for complex skin and soft tissue defects resulting from NSTIs, particularly when skin grafting is not suitable.
• This review underscores the critical role of plastic surgeons within multidisciplinary teams for managing NSTI patients.
• The findings support the use of various flap techniques, especially loco-regional options, in the comprehensive treatment of NSTIs.