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Free versus pedicled flaps for hand reconstruction: A systematic review and meta-analysis
Haya Abdulaziz Alzahrani1, Mohammed Nasser Asiri2, Abdulsalam M Humedi3
1Faculty of Medicine, Al-Baha University, Jeddah, Saudi Arabia.
JPRAS Open
|July 23, 2025
Summary
Free flaps reduce revision surgeries in hand reconstruction, while pedicled flaps show fewer infections and necrosis. This systematic review compares flap outcomes for plastic surgery.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Microsurgery
Background:
- Hand reconstruction addresses diverse conditions including congenital, traumatic, and degenerative issues.
- Free and pedicled flaps are established techniques for repairing hand defects.
Purpose of the Study:
- To systematically compare the clinical outcomes of free flaps versus pedicled flaps in hand reconstruction procedures.
Main Methods:
- A systematic literature search was performed in October 2024 across major databases (PubMed, Web of Science, Ovid MEDLINE).
- Keywords included "free tissue flaps," "pedicled flaps," and "hand reconstruction."
- Eligible studies (RCTs, cohort, clinical trials) were analyzed for flap survival, complications, and patient satisfaction.
Main Results:
- Nine studies encompassing 839 hands were reviewed.
- Free flaps demonstrated a significantly lower rate of revision surgery (24% vs. 61%).
- Pedicled flaps exhibited lower rates of infection (8% vs. 13%) and flap necrosis (8% vs. 9%).
Conclusions:
- Free flaps are associated with reduced need for revision surgeries in hand reconstruction.
- Pedicled flaps may offer advantages in terms of fewer infectious complications and less flap necrosis.
- This systematic review provides Level III evidence for comparing these reconstructive techniques.
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