Flap coverage for necrotising soft tissue infections: A systematic review |
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| Affiliation: | 1. Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada;2. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Canada;1. Department of Dermatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands;2. Department of Urology, LUMC, Leiden, the Netherlands;3. Department of Urology, University of Bern, Bern, Switzerland;4. Amsterdam UMC Location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands;5. Burn Center and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, the Netherlands;1. Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland;2. Department of Plastic and Hand Surgery, Lausanne University Hospital, Lausanne, Switzerland;3. Departments of Epidemiology and Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland;4. Department of Plastic Surgery and Hand Surgery, Burn Center, University and University Hospital Zurich, Switzerland;5. Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, Aarau, Switzerland;1. Department of Surgery School of Medicine, Iran University of Medical Sciences, Iran;2. Department of General Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran;3. Department of Psychiatry School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran;4. Iran University of Medical Sciences, Tehran, Iran;5. Department of Plastic Surgery, School of Medicine, Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, Iran;1. Shriners Hospitals for Children — Boston, Boston, MA, United States;2. Department of Surgery, Massachusetts General Hospital, Boston, MA, United States;3. University of North Carolina at Chapel Hill, School of Nursing, Hillman Scholars in Nursing Innovation, Chapel Hill, NC, United States;4. Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States;5. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States;6. Harvard Medical School, Boston, MA, United States;7. Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX, United States;8. Shriners Hospitals for Children — Galveston, Galveston, TX, United States;9. Shriners Hospital for Children — Northern California, Sacramento, CA, United States;10. University of California Davis School of Medicine, Department of Surgery, Division of Burn Surgery, Sacramento, CA, United States;11. Weill Cornell Medicine, New York, NY, United States;12. Shriners Hospital for Children — Cincinnati, Cincinnati, OH, United States;13. Department of Psychology, University of Massachusetts — Boston, Boston, MA, United States;14. Department of Surgery, University of Cincinnati, Cincinnati, OH, United States;15. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States;p. Spaulding Research Institute, Boston, MA, United States;1. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;2. Doctors Collaborating to Help Children, Boston, MA, United States;3. Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States;4. Shriners Hospitals for Children - Boston, Boston, MA, United States;5. Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States;6. Department of Pediatric Surgery, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine;7. Medicover Group, Lviv, Ukraine |
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| Abstract: | BackgroundNecrotising soft tissue infections (NSTI) are destructive and often life-threatening infections of the skin and soft tissue, necessitating prompt recognition and aggressive medical and surgical treatment. After debridement, the aim of surgical closure and reconstruction is to minimize disability and optimize appearance. Although skin grafting may fulfil this role, techniques higher on the reconstructive ladder, including local, regional and free flaps, are sometimes undertaken. This systematic review sought to determine the circumstances when this is true, which flaps were most commonly employed, and for which anatomical areas.MethodsA systematic review of the literature was conducted utilising electronic databases (Medline, Embase, Cochrane Library). Full text studies of flaps used for the management of NSTI’s (including Necrotising Fasciitis and Fournier Gangrene) were included. The web-based program ‘Covidence’ facilitated storage of references and data management. Data obtained in the search included reference details (journal, date and title), the study design, the purpose of the study, the study findings, number of patients with NSTI included, the anatomical areas of NSTI involved, the types of flaps used, and the complication rate.ResultsAfter screening 4555 references, 501 full text manuscripts were assessed for eligibility after duplicates and irrelevant studies were excluded. 230 full text manuscripts discussed the use of 888 flap closures in the context of NSTI in 733 patients; the majority of these were case series published in the last 20 years in a large variety of journals. Reconstruction of the perineum following Fournier’s gangrene accounted for the majority of the reported flaps (58.6%). Free flaps were used infrequently (8%), whereas loco-regional muscle flaps (18%) and loco-regional fasciocutaneous flaps (71%) were employed more often. The reported rate of partial or complete flap loss was 3.3%.ConclusionComplex skin and soft tissue defects from NSTIs, not amenable to skin grafting, can be more effectively and durably covered using a spectrum of flaps. This systematic review highlights the important contribution that the plastic surgeon makes as an integral member of multidisciplinary teams managing these patients. |
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| Keywords: | Necrotising soft tissue infection Fourniers gangrene Necrotising/necrotizing fasciitis Flap Burn centre/center |
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