{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T11:30:03Z","timestamp":1781350203212,"version":"3.54.1"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T00:00:00Z","timestamp":1624320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In free osteofasciocutaneous fibula flaps, secondary donor sites are avoided using one of three local closure methods: full\u2010thickness skin grafts (FTSGs), split\u2010thickness skin grafts (STSGs), or flaps. This systemic review aimed to evaluate the differences in outcomes among the three groups of closure methods used for free fibula flap defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In accordance with the Preferred Reporting Items for Systematic Reviews and Meta\u2010analyses (PRISMA) guidelines, we systematically searched the PubMed and Web of Science medical databases from inception to January 2021 for articles focused on closure of the free fibula flap donor site using the lower leg area\u2014local skin graft or flap\u2014that mentioned the free fibula flap defect size, and\/or complications of the donor site. Study characteristics, free fibula flap size, and short\u2010term complication rates were extracted for analysis. The pooled complication rates and confidence intervals were calculated based on the random\u2010effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven studies were included in the qualitative synthesis, and ten studies were included in the quantitative synthesis (meta\u2010analysis). The FTSG (<jats:italic>n<\/jats:italic>\u00a0=\u00a079, 52.3%) was the most widely used method, while both STSG (<jats:italic>n<\/jats:italic>\u00a0=\u00a036, 23.8%) and flap (<jats:italic>n<\/jats:italic>\u00a0=\u00a036, 23.8%) were the least commonly used methods. The mean free fibula flap length and width were largest for the flap method (11.5\u2009\u00b1\u20092.5\u00a0cm and 6.0\u2009\u00b1\u20091.8\u00a0cm), and all closure methods were used for free fibula flap widths \u22653\u00a0cm. Rates of partial and complete necrosis were highest for the FTSG method (20.3%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.95, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) and lowest for the flap method (12.7%, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.95, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This systemic review indicated that any closure method could be adapted for a free fibula flap width ranging from 3 to 9\u00a0cm, and the flap method was associated with the lowest rate of short\u2010term complications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30781","type":"journal-article","created":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T12:36:07Z","timestamp":1624365367000},"page":"192-198","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Closure of a free osteofasciocutaneous fibula flap donor site using local skin grafts or flaps: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-4147","authenticated-orcid":false,"given":"Keisuke","family":"Shimbo","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hiroshima Prefectural Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukako","family":"Okuhara","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hiroshima Prefectural Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Yokota","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Hiroshima University Hospital  Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10006-016-0556-3"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001891"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30621"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2020.102536"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30692"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.134.12.1324"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182402d9a"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318221dc2a"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.28232"},{"key":"e_1_2_9_12_1","volume-title":"Study quality assessment tools","author":"NIH","year":"2021"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2015.07.010"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e318248b813"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2019.08.008"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/2000656X.2021.1883631"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000637-199705000-00005"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-4356(02)00134-1"},{"key":"e_1_2_9_19_1","first-page":"40","article-title":"Autonomous reparative unit (ARU): A new concept of repairing free flap donor site with local full\u2010thickness skin graft","volume":"30","author":"Squadrelli\u2010Saraceno M.","year":"2010","journal-title":"Acta Otorhinolaryngologica Italica"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.1994.01880300047007"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2006.11.042"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2015.08.015"},{"key":"e_1_2_9_23_1","unstructured":"WellsGA SheaB O'ConnellD PetersonJ WelchV LososM TugwellP. 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