SynthesisBMC surgery2026
Meta-analysis of the safety and efficacy of flap reconstruction in the treatment of diabetic foot ulcers.
Synthesis in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo systematically evaluate the safety and efficacy of flap reconstruction surgery and the associated influential factors in the treatment of diabetic foot ulcers (DFUs) and to provide an evidence-based basis for clinical flap selection and surgical strategies.
methodsThe PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify studies on comparative or single-arm flap reconstruction for the treatment of diabetic foot ulcers (DFUs). Eligible study designs included randomized controlled trials (RCTs), cohort studies, and case series published between 1998 and 2025. Two investigators independently screened the literature, extracted relevant data, and assessed the risk of bias using the Cochrane Risk of Bias tool and the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Meta-analyses were performed using Review Manager (RevMan) 5.4. The primary and secondary outcome measures included total flap loss, limb loss rate, and flap failure rate. Subgroup analyses were conducted according to flap type and regional differences.
resultsA total of 45 studies were included. The results of the meta-analysis showed that patients undergoing flap reconstruction had higher postoperative total flap loss (HR = 5.83; 95% CI 3.65-9.31), limb loss (HR = 11.09; 95% CI 7.22-17.03), and flap failure rate (HR = 10.01; 95% CI 8.31-12.05) compared with reference populations or expected baseline risks. Subgroup analyses revealed that the risk of free flap limb loss was significantly greater than that of non-free flaps (HR = 17.86 vs. 1.94; P = 0.02); the risk of limb loss was greater in Europe (HR = 22.97) and North America (HR = 17.42) than in East Asia (HR = 5.85; P < 0.001), and there was no regional difference in total flap loss (P = 0.67). The results of the sensitivity analysis were robust, with heterogeneity arising mainly from differences in study design and patient characteristics.
conclusionFlap reconstruction remains a viable option for DFU wound closure, but it is associated with elevated risks of postoperative total flap loss and limb loss. Individualized surgical protocols, prioritization of non-free flaps for low- and intermediate-risk patients, and enhanced multidisciplinary collaboration and postoperative management are recommended. More high-quality studies are needed to validate the long-term efficacy of different flap techniques.
trial registrationRegister with PROSPERP, Registration Information: ID: CRD420251075758. Date of first submission to PROSPERO: 25 June 2025. Upload data information: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251075758.
Indexed as
Identifiers
What OpenQuestion holds
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.