ReviewJPRAS open2023
Strategies Following Free Flap Failure in Lower Extremity Trauma: A Systematic Review.
Review in JPRAS open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Free Flap Reconstruction in Burns: A Systematic Review of Current Practices and Evidence.Microsurgery · 2025Pooled it
- The Top 100 Most Cited Articles in Reconstructive Microsurgery: Identifying Evidence Gaps and Research Trends for Future Investigation: A Bibliometric and Visualization Analysis.Archives of plastic surgery · 2026Article
- Intraoperative indocyanine green versus clinical assessment for prevention of free flap failure: A systematic review and meta-analysis.JPRAS open · 2026Review
- Salvage surgery for free flap failure in the maxillofacial region: a comprehensive review of principles and outcomes.Annals of medicine and surgery (2012) · 2026Article
- Venous-trapezium coupler anastomosis in a partially congested combined ALT/TFL-flap: A case report.JPRAS open · 2026Article
- Novel Porcine Xenograft as a Salvage Strategy for Lower Extremity Wound Reconstruction Following Free Flap Failure.Plastic and reconstructive surgery. Global open · 2026Article
- A Meta-analysis of Nontraditional Uses of Deep Inferior Epigastric Artery Perforator Flaps.Plastic and reconstructive surgery. Global open · 2026Article
- Factors Associated With Venous Complications in Lower Extremity Free Flap Reconstruction: A Multivariate Analysis.Plastic and reconstructive surgery. Global open · 2026Article
- Risk Factors Associated with Adverse Functional Outcomes in Free Flap Reconstructions of the Lower Extremity.Plastic and reconstructive surgery. Global open · 2026Article
- Article
- Open Tibial Fractures Part 2: A Narrative Review of Definitive Treatment and Potential Applicability to the Southern African Context.Orthopedic research and reviews · 2026Review
- Timing for Free-Flap Reconstruction for Gustilo Type III Lower Limb Fractures: Systematic Review and Meta-analysis.Plastic and reconstructive surgery. Global open · 2025Article
- Orthoplastic tarsal reconstruction using a chimeric vascularized bone graft in a heavy smoker: a case report.Journal of surgical case reports · 2025Article
- Soft Tissue Reconstruction in the Extremities: Principles, Techniques, and Outcomes.Seminars in plastic surgery · 2025Review
- Microsurgical Reconstruction of Extensive Lower Limb Defects: Latissimus Dorsi Free Flap for Circumferential Soft Tissue Loss Following High-Energy Trauma.Journal of clinical medicine · 2025Article
- The Impact of pre-operative aspirin administration on free flap survival rate in lower extremity reconstructio n.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Article
- "Y" Configuration of the Arterial Pedicle or the Use of a Saphenous Vein Graft for Microsurgical Reconstruction in the Old and Diseased-A Retrospective Study.Journal of clinical medicine · 2024Article
- Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery.Journal of clinical medicine · 2024Article
- Medial Gastrocnemius Tenocutaneous Island Flap: A Salvage Option After Free Flap Compromise in the Lower Limb.Cureus · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Free flap reconstructions are an important reconstructive option for soft tissue defects in mangled lower extremities. Microsurgery facilitates soft tissue coverage of defects that otherwise would result in amputation. However, the success rates of traumatic lower extremity free flap reconstructions remain lower than those in other locations. Nevertheless, post-free flap failure salvage strategies have rarely been addressed. Therefore, the current review aims to provide an overview of post-free flap failure strategies in lower extremity trauma and their subsequent outcomes. Methods: A search of Pubmed, Cochrane, and Embase databases was performed on June 9, June 2021 using the following medical subject headings (MeSH) search terms: 'lower extremity', 'leg injuries', 'reconstructive surgical procedures', 'reoperation', 'microsurgery' and 'treatment failure'. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Partial and total free flap failures after traumatic reconstruction were included. Results: Twenty-eight studies with a total of 102 free flap failures fulfilled the eligibility criteria. Following the total failure, a second free flap is the predominant reconstructive strategy (69%). In comparison to the failure rate of a first free flap (10%), the fate of a second free flap is less favorable with a failure rate of 17%. The amputation rate following flap failure is 12%. The risk of amputation increases between primary and secondary free flap failures. After partial flap loss, the preferred strategy is a split skin graft (50%). Conclusion: To our knowledge, this is the first systematic review on the outcome of salvage strategies after free flap failure in traumatic lower extremity reconstruction. This review provides valuable evidence to take into consideration in the decision-making regarding post-free flap failure strategies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.