Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction: Systematic Review and Meta-Analysis

Carly M Fox, Henry M Beem, Jonathan D Wiper, Warren M Rozen, Michael Wagels, James Chin Sek Leong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Management of soft tissue injuries of the heel is challenging and the composition of free tissue transfer that provides optimal aesthetic and functional outcomes in heel reconstruction is not clear. While fasciocutaneous flaps may result in shear planes that cause instability with mobilization, insensate muscle flaps may not be able to withstand the pressures of weight bearing and thus ulcerate. Methods A systematic literature search was performed using Medline and PubMed databases. Primary outcome measures were time to mobilize, ulceration, revision or debulking surgery, and the requirement for specialized footwear. Analysis of pooled outcomes was undertaken using fixed-effects meta-analysis, calculating the incidence rate ratio for included articles. Results Overall 576 articles were identified; out of which 11 articles met the final inclusion criteria, detailing 168 free tissue transfers in 163 patients. The study size ranged from 4 to 72 cases. There was a trend toward higher rates of ulceration (17 vs. 26%), requirement for revision (23 vs. 31%), and the requirement for specialized footwear (35 vs. 56%) in muscle flaps, but these differences were not statistically significant. Conclusion The current review provided a summary of reported outcomes of free heel reconstruction in the literature till date. With the current evidence largely limited to small cohort studies (level IV evidence), there were no significant differences found between reconstructive options. These findings serve as a call to action for more reconstructive surgeons to collaborate on multi-institutional prospective studies with robust outcomes assessment. As such, an ideal flap for reconstruction of the weight-bearing heel has not yet been made clear.

Original languageEnglish
Pages (from-to)59-66
Number of pages8
JournalJournal of Reconstructive Microsurgery
Volume31
Issue number1
DOIs
Publication statusPublished - 1 Aug 2015

Keywords

  • fasciocutaneous
  • musculocutaneous
  • reconstruction
  • weight-bearing heel

Cite this

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title = "Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction: Systematic Review and Meta-Analysis",
abstract = "Background Management of soft tissue injuries of the heel is challenging and the composition of free tissue transfer that provides optimal aesthetic and functional outcomes in heel reconstruction is not clear. While fasciocutaneous flaps may result in shear planes that cause instability with mobilization, insensate muscle flaps may not be able to withstand the pressures of weight bearing and thus ulcerate. Methods A systematic literature search was performed using Medline and PubMed databases. Primary outcome measures were time to mobilize, ulceration, revision or debulking surgery, and the requirement for specialized footwear. Analysis of pooled outcomes was undertaken using fixed-effects meta-analysis, calculating the incidence rate ratio for included articles. Results Overall 576 articles were identified; out of which 11 articles met the final inclusion criteria, detailing 168 free tissue transfers in 163 patients. The study size ranged from 4 to 72 cases. There was a trend toward higher rates of ulceration (17 vs. 26{\%}), requirement for revision (23 vs. 31{\%}), and the requirement for specialized footwear (35 vs. 56{\%}) in muscle flaps, but these differences were not statistically significant. Conclusion The current review provided a summary of reported outcomes of free heel reconstruction in the literature till date. With the current evidence largely limited to small cohort studies (level IV evidence), there were no significant differences found between reconstructive options. These findings serve as a call to action for more reconstructive surgeons to collaborate on multi-institutional prospective studies with robust outcomes assessment. As such, an ideal flap for reconstruction of the weight-bearing heel has not yet been made clear.",
keywords = "fasciocutaneous, musculocutaneous, reconstruction, weight-bearing heel",
author = "Fox, {Carly M} and Beem, {Henry M} and Wiper, {Jonathan D} and Rozen, {Warren M} and Michael Wagels and Leong, {James Chin Sek}",
year = "2015",
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language = "English",
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Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction : Systematic Review and Meta-Analysis. / Fox, Carly M; Beem, Henry M; Wiper, Jonathan D; Rozen, Warren M; Wagels, Michael; Leong, James Chin Sek.

In: Journal of Reconstructive Microsurgery, Vol. 31, No. 1, 01.08.2015, p. 59-66.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Muscle versus Fasciocutaneous Free Flaps in Heel Reconstruction

T2 - Systematic Review and Meta-Analysis

AU - Fox, Carly M

AU - Beem, Henry M

AU - Wiper, Jonathan D

AU - Rozen, Warren M

AU - Wagels, Michael

AU - Leong, James Chin Sek

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background Management of soft tissue injuries of the heel is challenging and the composition of free tissue transfer that provides optimal aesthetic and functional outcomes in heel reconstruction is not clear. While fasciocutaneous flaps may result in shear planes that cause instability with mobilization, insensate muscle flaps may not be able to withstand the pressures of weight bearing and thus ulcerate. Methods A systematic literature search was performed using Medline and PubMed databases. Primary outcome measures were time to mobilize, ulceration, revision or debulking surgery, and the requirement for specialized footwear. Analysis of pooled outcomes was undertaken using fixed-effects meta-analysis, calculating the incidence rate ratio for included articles. Results Overall 576 articles were identified; out of which 11 articles met the final inclusion criteria, detailing 168 free tissue transfers in 163 patients. The study size ranged from 4 to 72 cases. There was a trend toward higher rates of ulceration (17 vs. 26%), requirement for revision (23 vs. 31%), and the requirement for specialized footwear (35 vs. 56%) in muscle flaps, but these differences were not statistically significant. Conclusion The current review provided a summary of reported outcomes of free heel reconstruction in the literature till date. With the current evidence largely limited to small cohort studies (level IV evidence), there were no significant differences found between reconstructive options. These findings serve as a call to action for more reconstructive surgeons to collaborate on multi-institutional prospective studies with robust outcomes assessment. As such, an ideal flap for reconstruction of the weight-bearing heel has not yet been made clear.

AB - Background Management of soft tissue injuries of the heel is challenging and the composition of free tissue transfer that provides optimal aesthetic and functional outcomes in heel reconstruction is not clear. While fasciocutaneous flaps may result in shear planes that cause instability with mobilization, insensate muscle flaps may not be able to withstand the pressures of weight bearing and thus ulcerate. Methods A systematic literature search was performed using Medline and PubMed databases. Primary outcome measures were time to mobilize, ulceration, revision or debulking surgery, and the requirement for specialized footwear. Analysis of pooled outcomes was undertaken using fixed-effects meta-analysis, calculating the incidence rate ratio for included articles. Results Overall 576 articles were identified; out of which 11 articles met the final inclusion criteria, detailing 168 free tissue transfers in 163 patients. The study size ranged from 4 to 72 cases. There was a trend toward higher rates of ulceration (17 vs. 26%), requirement for revision (23 vs. 31%), and the requirement for specialized footwear (35 vs. 56%) in muscle flaps, but these differences were not statistically significant. Conclusion The current review provided a summary of reported outcomes of free heel reconstruction in the literature till date. With the current evidence largely limited to small cohort studies (level IV evidence), there were no significant differences found between reconstructive options. These findings serve as a call to action for more reconstructive surgeons to collaborate on multi-institutional prospective studies with robust outcomes assessment. As such, an ideal flap for reconstruction of the weight-bearing heel has not yet been made clear.

KW - fasciocutaneous

KW - musculocutaneous

KW - reconstruction

KW - weight-bearing heel

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U2 - 10.1055/s-0034-1384674

DO - 10.1055/s-0034-1384674

M3 - Article

VL - 31

SP - 59

EP - 66

JO - Journal of Reconstructive Microsurgery

JF - Journal of Reconstructive Microsurgery

SN - 0743-684X

IS - 1

ER -