Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction. A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model. Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (I2 = 0% 95% CI: 97.7-99.6) of pedicled and 90.1% (I2 = 82.8% 95% CI: 62.7-100) of free flap reconstructions, recurring in 1.8% (I2 = 0% 95% CI: 0.7-3.3) at sites reconstructed with pedicled flaps and 0.6% (I2 = 0% 95% CI: 0.1-1.7) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (I2 = 0% 95% CI: 0.6-2.7) and 2.9% (I2 = 37.9% 95% CI: 0.9-5.8) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (I2 = 65.1% 95% CI: 3.4-11.5) and 5.2% (I2 = 65% 95% CI: 1.7-10.4) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (p = 0.50), contracture recurrence (p = 0.15), total flap loss (p = 0.18) or partial flap loss (p = 0.31) regardless of the flap type used. Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.
Elemosho et al. (Fri,) studied this question.