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Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review
Adaah A Sayyed1, Jenna C Bekeny1, Jonathan Day2
1Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia.
Journal of Reconstructive Microsurgery
|June 23, 2022
Summary
Composite free tissue transfers are effective for reconstructing lower extremity tendon and soft tissue defects. The anterolateral thigh and fascia lata flap offers good outcomes, including return to ambulation and high patient satisfaction.
Area of Science:
- Orthopedic Surgery
- Plastic Surgery
- Regenerative Medicine
Background:
- Tendon rupture with extensive soft tissue loss presents limited reconstructive options.
- Composite free tissue transfers, incorporating skin and tendon, offer a promising solution.
- Existing evidence is largely based on case reports, necessitating a systematic review.
Approach:
- A systematic review following PRISMA guidelines was conducted.
- Searched OvidMEDLINE using MeSH terms like "lower extremity," "tendon," and "composite flap."
- Analyzed 29 articles on 173 patients, collecting data on defect characteristics, functional outcomes, and complications.
Key Points:
- The anterolateral thigh and fascia lata (ALT+FL) flap was the most common (58.0%).
- Average defect sizes were 8.4 cm for tendon and 80.2 cm² for soft tissue.
- 99.3% of patients returned to ambulation within an average of 123.1 days.
Conclusions:
- Composite flaps are effective for reconstructing diverse lower extremity tendon and soft tissue defects.
- The ALT+FL flap is well-suited for Achilles, patellar, and other tendon defects, promoting rapid healing.
- Patients experienced return to ambulation, minimal range of motion impairment, and high satisfaction post-reconstruction.
