Combined revascularization and free flap reconstruction for chronic limb-threatening ischemia: A systematic review and meta-analysis.

Background Combined revascularization and free flap reconstruction is one treatment method for chronic limb-threatening ischemia (CLTI) with complex wounds. The purpose of this systematic review and meta-analysis was to investigate the characteristics of this combined procedure and to assess postoperative outcomes. Methods A systematic search was performed across PubMed, Scopus, and the Web of Science for studies between January 2000 and February 2022. A random-effects meta-analysis for postoperative outcome was conducted. Results Fifteen articles encompassing 1,176 patients with 1,194 free flaps were ultimately included in the qualitative and quantitative assessment. Our meta-analysis showed the following complication rates for short-term postoperative outcomes: 37% (95% CI, 18%-53%; I2 = 74%) for reoperation, 13% (95% CI, 2%-24%; I2 = 0%) for vascular thrombosis, 9% (95% CI, 0%-17%; I2 = 0%) for total flap failure, 8% (95% CI, 0%-17%; I2 = 0%) for partial flap failure, 4% (95% CI, 0%-10%; I2 = 0%) for amputation, and 3% (95% CI, 0%-9%; I2 = 0%) for 30-day mortality. The 1-, 3-, and 5-year limb salvage rates were 86% (95% CI, 78%-92%), 81% (95% CI, 68%-88%), and 71% (95% CI, 53%-83%), respectively. The 1-, 3-, and 5-year patient survival rates were 93% (95% CI, 90%-96%), 92% (95% CI, 77%-97%), and 75% (95% CI, 50%-88%), respectively. Conclusion Combined revascularization and free flap reconstruction for CLTI with complex wounds was clearly effective for the long-term outcomes. However, this combined procedure should be considered on the assumption that the reoperation rate is high and that flap-related complications rate may be higher than lower extremity reconstruction of other etiologies.