The Versatility of the DCIA Free Flap: A Forgotten Flap? Systematic Review and Meta-Analysis.

BACKGROUND: Studies reporting on the deep circumflex iliac artery (DCIA) free flap are restricted to a limited number of patients and areas of application. The aim of this review was to assess the reliability and versatility of the DCIA free flap during reconstruction. METHODS: A comprehensive review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, Web of Science, Cochrane CENTRAL, and SCOPUS. A critical analysis of pooled data was performed to assess outcomes employing the DCIA free flap. RESULTS: A total of 445 DCIA free flaps were included. The main recipient sites were head and neck (72.35%), lower extremity (20.67%), and upper extremity (6.74%). The main indications for reconstruction were tumor resection (73.8%) and trauma (17.43%). Fifty non-DCIA flaps were required to finalize the reconstruction of several defects. The pooled flap failure rate using the DCIA free flap was 4% (95% confidence interval: 1-8%). No significant heterogeneity was present across studies (Q statistic 22.12, p = 0.14; I 2 = 27.68%, p = 0.139). Complication rates for head and neck and limb reconstruction were 57.37 and 40.16%, respectively. The average length and surface area of bone flaps were 7.79 cm and 22.8 cm2, respectively. The area of the skin paddles was 117 cm2. CONCLUSION: The DCIA free flap has shown to be a versatile reconstructive alternative for head and neck and short-medium size limb defects. However, the complexity of functions, the recipient site location, and a potential large defect can detract from the use of the DCIA free flap as an initial reconstructive option for head and neck and extensive limb defects.

Intrafamilial transmission and clustering of COVID-19: a socioepidemiological perspective.

INTRODUCTION: The dynamics of COVID-19 transmission occurring in familial clusters may be related to sociodemographic and epidemiological characteristics of cases and contacts. The aim of this study was to identify the dynamics of COVID-19 transmission in families with more than one documented case. METHODOLOGY: Data of about 58 familiar clusters of COVID-19 was gathered and followed up clinically and by telephonic interview. Age, gender, social security plan, comorbidities, occupation, incubation, and symptoms were analyzed using Students' t-test and Chi squared test. RESULTS: The contacts were younger and healthier than cases, and students were predominant (28%). Among the symptomatic contacts, reverse transcription polymerase chain reaction yielded a positive rate of 69%. There were 2.93 contacts per case. Families with clustered cases had more family members when compared to families without clustered cases (4.2 vs. 3.3; p = 0.022). Mean age of contacts in families with clustered cases compared to families without clustered cases also showed differences (29.5 vs. 35.7; p = 0.047). CONCLUSIONS: Characterization of cases and contacts amidst a pandemic is essential for the effective implementation of health policies and research perspectives.