Patient-reported outcomes following free flap lower extremity reconstruction: A systematic review and meta-analysis

Published:October 15, 2022DOI:



      Free flap reconstruction in the lower extremity has shown success for the management of large and complex defects, restoration of function, and favorable aesthetic outcomes. Patient-reported outcomes (PROs) have not been well explored in previous literature. This meta-analysis aimed to provide a comprehensive summary of PROs after free flap reconstruction in the lower extremity.


      We searched MEDLINE and Embase from 1946 to 2021 for studies reporting on PROs following free flap reconstruction in the lower extremity.


      Overall, 53 studies were included, and 11 studies reported validated PRO measures for meta-analysis. A total of 1953 patients underwent reconstruction with 1958 free flaps for lower limb defects with a mean follow-up of 3.26 (0.25–7.83) months. The mean postoperative Lower Extremity Functional Scale (LEFS) scores were 60.3 (±12) out of 80 points (4 studies, 85 patients). The mean postoperative AOFAS scores were 75.1 (±15) out of 100 points (4 studies, 68 patients). The mean postoperative SF-36 scores were 88.1 (±8.0) out of 100 points; mental health component was 48.7 (±8.9), and physical component was 38.4 (±8.2), out of 50 points (4 studies, 88 patients).


      Our findings demonstrated that patients report improved physical health, mental health, and function following lower extremity reconstruction with free flaps. Patients reported similar improvements in functional scores following lower extremity reconstruction regardless of their free flap type. Furthermore, patients with myocutaneous flaps may have improved mental health and worse physical health scores when compared to perforator flaps. The evidence profiles presented in this review indicate that additional research is needed to help guide future decision-making.


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      Linked Article

      • Commentary: Standardization of patient reported outcomes in lower extremity reconstruction
        Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 76
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          Lower extremity defects cause significant morbidity to patients, both in form and function.1 Fortunately, there exists a wide range of options for lower extremity reconstruction (LER), with donor sites including the anterolateral thigh, latissimus dorsi, and gracilis, as well as a choice for myocutaneous versus fasciocutaenous tissue.2 Although outcomes such as complications, flap survival, and function are well described in the literature3, patient reported outcomes (PRO) are underreported and should be taken into consideration for flap selection.
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