부산대학교 도서관

Background: The anterolateral thigh (ALT) free flap is commonly used for complex lower limb reconstruction. Recently, other thin perforator flaps—such as the thin-ALT flap and the superficial circumflex iliac artery perforator (SCIP) flap—have become increasingly utilized in this indication. There is limited evidence examining the performance of these thin suprafascial flaps to the standard ALT flap. We aim to systematically review the literature, assessing the survival and complication rates of the standard ALT, thin-ALT, and SCIP flaps in lower limb reconstruction. Methods: Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, Embase®, MEDLINE®, and Web of Science® on Jan. 27, 2021. Only primary English studies published in peer-reviewed scientific journals and that explored lower limb reconstruction were included. Results: We included 68 studies, comprising 1652 standard ALT, 187 thin-ALT, and 129 SCIP flaps. Thin-ALT flaps demonstrated significantly lower rates of full flap failure (0.6%, N = 1/187) compared to standard ALT flaps (3.9%, N = 64/1652). Thin-ALT and SCIP flaps have been more frequently used in foot reconstruction (47.6%, N = 50/105; 82.9%, N = 29/35 respectively), whereas standard ALT flaps have been more frequently used in leg (43.0%, N = 182/423) and trauma-related reconstructions (84.3%, N = 334/396). Thin-ALT and SCIP flaps have a smaller mean surface area, as well as significantly lower rates of thinning (6.2%, N = 5/80; 4.5%, N = 5/112, respectively) compared to standard ALT flaps (26.1%, N = 43/165). Conclusions: Thin-ALT and SCIP flaps demonstrate low rates of flap failure and secondary complications that are comparable to standard ALT flaps. Thin-ALT and SCIP flaps are viable options for complex lower extremity reconstruction. Level of evidence: Not gradable [ABSTRACT FROM AUTHOR]