Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis
K.K. Kilian,
A.C. Panayi,
D.Y. Matar,
C. Hamwi,
A.K. Bigdeli,
U. Kneser,
F.H. Vollbach
Affiliations
K.K. Kilian
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
A.C. Panayi
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
D.Y. Matar
Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
C. Hamwi
Department of Data Science, Saint Louis University, St. Louis, MO, USA
A.K. Bigdeli
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
U. Kneser
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
F.H. Vollbach
Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany; Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany; Corresponding author: Felix H. Vollbach, MD, Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany, Phone: +49 89-4400-73502; Fax: +49 89-4400-76505
Summary: Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI).Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors.This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups.This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
