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Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case
Abiramie Chellamuthu1, Sathish Kumar Jayaraman1, Ramesh B A1
1Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
Summary
Fasciocutaneous flaps (FCFs) offer better sensory recovery and earlier weight-bearing for heel reconstruction compared to muscle flaps (MFs). While outcomes like survival and revision rates showed no significant difference, FCFs facilitate a faster return to daily activities.
Area of Science:
- Orthopedic Surgery
- Plastic Surgery
- Regenerative Medicine
Background:
- Free flap component selection (fasciocutaneous vs. muscle) is a critical and debated aspect of heel reconstruction.
- This meta-analysis addresses the controversy by comparing fasciocutaneous flaps (FCFs) and muscle flaps (MFs) for heel reconstruction.
Purpose of the Study:
- To compare the efficacy of FCFs versus MFs in heel reconstruction.
- To determine if one flap type offers advantages over the other in terms of key reconstructive outcomes.
Main Methods:
- Systematic literature review following PRISMA guidelines, identifying studies on FCF and MF for heel reconstruction.
- Meta-analysis and Trial Sequential Analysis (TSA) of primary outcomes: survival, ambulation time, sensation, ulceration, gait, footwear needs, revisions, and shear.
- Pooled risk ratios (RRs) and standardized mean differences (SMDs) were calculated using fixed and random effects models.
Main Results:
- No significant differences were found between MFs and FCFs for flap survival, gait abnormality, ulcerations, footwear modification, or revision procedures.
- FCFs demonstrated superior sensory recovery, including deep pressure, light touch, and pain perception, compared to MFs.
- Time to full weight-bearing was significantly shorter for FCFs than for MFs (SMD, -3.03).
Conclusions:
- FCF reconstruction in heel defects leads to better sensory outcomes and earlier weight-bearing, promoting a faster return to daily activities.
- Both FCFs and MFs showed comparable results for footwear modification and revision procedures.
- Results for flap survival, gait assessment, and ulceration rates were inconclusive, necessitating further investigation, particularly regarding shear forces.
