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J Reconstr Microsurg 2022; 38(05): 378-389
DOI: 10.1055/s-0041-1733978
Original Article

The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis

Joseph M. Escandón 
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York
,
Valeria P. Bustos 
2   Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Lauren Escandón
3   School of Medicine, Universidad El Bosque, Los Cobos Medical Center, Bogotá DC, Colombia
,
Eric Santamaría
4   Department of Plastic and Reconstructive Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Cancer Institute, Mexico City, Mexico
,
Miguel A. Gaxiola-García 
5   Department of Plastic and Reconstructive Surgery, Mexico's Children Hospital Federico Gomez, Mexico City, Mexico
,
Beatriz H. Kushida-Contreras 
6   Department of Plastic and Reconstructive Surgery, Mexico's General Hospital, Mexico City, Mexico
,
Antonio J. Forte
7   Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
,
Pedro Ciudad
8   Department of Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
,
Howard N. Langstein
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York
,
Oscar J. Manrique
1   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, New York
› Author Affiliations Funding None.
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Abstract

Background Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction.

Methods A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap.

Results A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1–8%). No significant heterogeneity was present across studies (Q statistic 22.12, p = 0.14; I 2 = 27.68%, p = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm2, respectively. The area of the skin paddles was 117 cm2.

Conclusion The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.

Keywords

iliac artery - Meta-analysis - Reconstruction - composite bone flaps - microsurgery - microsurgical flaps

Supplementary Material



Publication History

Received: 18 March 2021

Accepted: 22 June 2021

Article published online:
28 August 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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