Outcomes of microsurgical free tissue transfer performed on international surgical collaborations in low-income and middle-income countries: A systematic review and meta-analysis

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2022-07, Vol.75 (7), p.2049-2063
• Main Authors: de Berker, Henry T, Čebron, Urška, Bradley, Daniel, Patel, Vinod, Berhane, Meklit, Almas, Fernando, Walton, Gary, Eshete, Mekonen, McGurk, Mark, Martin, Dominique, Honeyman, Calum
• Format: Article
• Language: English
• Subjects: Free flap; Free tissue transfer; International surgical collaborations; Low-income and middle-income countries; Microsurgery; Surgical missions
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2022.04.002

Microsurgical free tissue transfer is the gold standard for reconstruction of significant soft tissue and bony defects following cancer resection and trauma. Many reconstructive units in low-income and middle-income countries (LMICs) do not yet have access to the resources or training required to perform microsurgical procedures. Long-term international collaborations have been formed with annual reconstructive programmes conducting microsurgery. To critically analyze outcomes of microsurgical free tissue transfer performed on international reconstructive collaborations in LMICs. PRISMA-compliant systematic review and meta-analysis of outcomes for free tissue transfer performed during international collaborations in LMICs using an inverse variance model. The study protocol was published prospectively and registered with PROSPERO (ID: CRD42021225613). Seven studies, included 290 flaps on 284 patients. The most common sites requiring reconstruction were Head and neck (53% (n = 153)) and lower limb (7.9% (n = 23)) were lower limb reconstruction. The most common free flaps were radial forearm (22%; n = 64) and anterolateral thigh (18%; n = 51). Total Flap Failure rate was 3.8% (n = 13; 95% confidence interval (CI) = 1.9–6.3%) Overall complication rate was 38% (95% CI =27–48%), with 19% of flaps requiring emergency return to theatre (95% CI =14–26%). Flap salvage was successful in 52% of take-backs (95% CI =15% - 88%). Free flaps performed during international surgical collaborations in LMICs have comparable failure rates to those performed in higher-income settings. However, there are higher complication and take-back rates. This should be taken into account when planning international collaborations. These results should help preoperative counselling and the consent process.