Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis
Background Perforator‐based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single‐ and multiple‐perforator‐b...
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| Veröffentlicht in: | Microsurgery 2023-02, Vol.43 (2), p.185-195 |
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| creator | Yin, Shou‐cheng Liu, Yi‐hao Shi, Chao Qiao, Qi‐hui Xu, Zhong‐fei Feng, Cui‐juan |
| description | Background
Perforator‐based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single‐ and multiple‐perforator‐based free perforator flaps in free‐flap reconstruction.
Methods
We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated.
Results
Thirty‐two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple‐perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78–1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36–2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07–2.79, p = .026) than the single‐perforator group.
Conclusion
The rates of total loss, fat necrosis and venous insufficiency in the multiple‐perforator group were lower than those in the single‐perforator group. Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction. |
| doi_str_mv | 10.1002/micr.30955 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2712844894</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2712844894</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3165-2aafd3e9462ec9d64499b5e2e6f0a8c1960777b23c96372ef59bf4625e1cd8803</originalsourceid><addsrcrecordid>eNp90U1LHTEUBuBQWurVuukPkEA3RRibj_lI3MlFW0ERSl0PmcxJicxMxpyZXu7ObXf9jf0l5jq2QhddhROevITzEvKesxPOmPjUextPJNNF8YqsONMqE1UhXpMVq6TKOFPFHtlHvGOMaV3pt2RPlkyVWsoV-bkO_WiixzDQ4GiYJxt6QNrAtAEYKPrhewe_H35RM7S0n7vJj0_zCNGFaKYQ09AYhJa6CEBf7qnrzIin9IziFifozeQtjfDDw2YJg8mkt2Yw3RY9viNvnOkQDp_PA3J7cf5t_SW7uvl8uT67yqzkZZEJY1wrQeelAKvbMs-1bgoQUDpmlOW6ZFVVNUJaXcpKgCt04xIugNtWKSYPyMcld4zhfgac6t6jha4zA4QZa1FxofJc6TzRD__QuzDH9N-dSrvlWiiZ1PGibAyIEVw9Rt-buK05q3cF1buC6qeCEj56jpybHtq_9E8jCfAFbHwH2_9E1deX669L6CNbtqFE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2773819283</pqid></control><display><type>article</type><title>Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Yin, Shou‐cheng ; Liu, Yi‐hao ; Shi, Chao ; Qiao, Qi‐hui ; Xu, Zhong‐fei ; Feng, Cui‐juan</creator><creatorcontrib>Yin, Shou‐cheng ; Liu, Yi‐hao ; Shi, Chao ; Qiao, Qi‐hui ; Xu, Zhong‐fei ; Feng, Cui‐juan</creatorcontrib><description>Background
Perforator‐based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single‐ and multiple‐perforator‐based free perforator flaps in free‐flap reconstruction.
Methods
We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated.
Results
Thirty‐two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple‐perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78–1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36–2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07–2.79, p = .026) than the single‐perforator group.
Conclusion
The rates of total loss, fat necrosis and venous insufficiency in the multiple‐perforator group were lower than those in the single‐perforator group. Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction.</description><identifier>ISSN: 0738-1085</identifier><identifier>EISSN: 1098-2752</identifier><identifier>DOI: 10.1002/micr.30955</identifier><identifier>PMID: 36086933</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Complications ; Dehiscence ; Fat Necrosis ; Free Tissue Flaps ; Hematoma ; Hemorrhage ; Humans ; Meta-analysis ; Necrosis ; Perforator Flap ; Plastic Surgery Procedures ; Postoperative Complications - etiology ; Quality assessment ; Quality control ; Reconstruction ; Wound dehiscence ; Wounds</subject><ispartof>Microsurgery, 2023-02, Vol.43 (2), p.185-195</ispartof><rights>2022 Wiley Periodicals LLC.</rights><rights>2023 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3165-2aafd3e9462ec9d64499b5e2e6f0a8c1960777b23c96372ef59bf4625e1cd8803</cites><orcidid>0000-0003-1612-7578 ; 0000-0001-6276-0468 ; 0000-0002-8320-2526</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fmicr.30955$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fmicr.30955$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36086933$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yin, Shou‐cheng</creatorcontrib><creatorcontrib>Liu, Yi‐hao</creatorcontrib><creatorcontrib>Shi, Chao</creatorcontrib><creatorcontrib>Qiao, Qi‐hui</creatorcontrib><creatorcontrib>Xu, Zhong‐fei</creatorcontrib><creatorcontrib>Feng, Cui‐juan</creatorcontrib><title>Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis</title><title>Microsurgery</title><addtitle>Microsurgery</addtitle><description>Background
Perforator‐based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single‐ and multiple‐perforator‐based free perforator flaps in free‐flap reconstruction.
Methods
We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated.
Results
Thirty‐two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple‐perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78–1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36–2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07–2.79, p = .026) than the single‐perforator group.
Conclusion
The rates of total loss, fat necrosis and venous insufficiency in the multiple‐perforator group were lower than those in the single‐perforator group. Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction.</description><subject>Complications</subject><subject>Dehiscence</subject><subject>Fat Necrosis</subject><subject>Free Tissue Flaps</subject><subject>Hematoma</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Meta-analysis</subject><subject>Necrosis</subject><subject>Perforator Flap</subject><subject>Plastic Surgery Procedures</subject><subject>Postoperative Complications - etiology</subject><subject>Quality assessment</subject><subject>Quality control</subject><subject>Reconstruction</subject><subject>Wound dehiscence</subject><subject>Wounds</subject><issn>0738-1085</issn><issn>1098-2752</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90U1LHTEUBuBQWurVuukPkEA3RRibj_lI3MlFW0ERSl0PmcxJicxMxpyZXu7ObXf9jf0l5jq2QhddhROevITzEvKesxPOmPjUextPJNNF8YqsONMqE1UhXpMVq6TKOFPFHtlHvGOMaV3pt2RPlkyVWsoV-bkO_WiixzDQ4GiYJxt6QNrAtAEYKPrhewe_H35RM7S0n7vJj0_zCNGFaKYQ09AYhJa6CEBf7qnrzIin9IziFifozeQtjfDDw2YJg8mkt2Yw3RY9viNvnOkQDp_PA3J7cf5t_SW7uvl8uT67yqzkZZEJY1wrQeelAKvbMs-1bgoQUDpmlOW6ZFVVNUJaXcpKgCt04xIugNtWKSYPyMcld4zhfgac6t6jha4zA4QZa1FxofJc6TzRD__QuzDH9N-dSrvlWiiZ1PGibAyIEVw9Rt-buK05q3cF1buC6qeCEj56jpybHtq_9E8jCfAFbHwH2_9E1deX669L6CNbtqFE</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Yin, Shou‐cheng</creator><creator>Liu, Yi‐hao</creator><creator>Shi, Chao</creator><creator>Qiao, Qi‐hui</creator><creator>Xu, Zhong‐fei</creator><creator>Feng, Cui‐juan</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>7T7</scope><scope>7TK</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1612-7578</orcidid><orcidid>https://orcid.org/0000-0001-6276-0468</orcidid><orcidid>https://orcid.org/0000-0002-8320-2526</orcidid></search><sort><creationdate>202302</creationdate><title>Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis</title><author>Yin, Shou‐cheng ; Liu, Yi‐hao ; Shi, Chao ; Qiao, Qi‐hui ; Xu, Zhong‐fei ; Feng, Cui‐juan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3165-2aafd3e9462ec9d64499b5e2e6f0a8c1960777b23c96372ef59bf4625e1cd8803</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Complications</topic><topic>Dehiscence</topic><topic>Fat Necrosis</topic><topic>Free Tissue Flaps</topic><topic>Hematoma</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Meta-analysis</topic><topic>Necrosis</topic><topic>Perforator Flap</topic><topic>Plastic Surgery Procedures</topic><topic>Postoperative Complications - etiology</topic><topic>Quality assessment</topic><topic>Quality control</topic><topic>Reconstruction</topic><topic>Wound dehiscence</topic><topic>Wounds</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yin, Shou‐cheng</creatorcontrib><creatorcontrib>Liu, Yi‐hao</creatorcontrib><creatorcontrib>Shi, Chao</creatorcontrib><creatorcontrib>Qiao, Qi‐hui</creatorcontrib><creatorcontrib>Xu, Zhong‐fei</creatorcontrib><creatorcontrib>Feng, Cui‐juan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Microsurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yin, Shou‐cheng</au><au>Liu, Yi‐hao</au><au>Shi, Chao</au><au>Qiao, Qi‐hui</au><au>Xu, Zhong‐fei</au><au>Feng, Cui‐juan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis</atitle><jtitle>Microsurgery</jtitle><addtitle>Microsurgery</addtitle><date>2023-02</date><risdate>2023</risdate><volume>43</volume><issue>2</issue><spage>185</spage><epage>195</epage><pages>185-195</pages><issn>0738-1085</issn><eissn>1098-2752</eissn><abstract>Background
Perforator‐based free perforator flaps have become an important tool for the reconstruction of tissue defects. The effect of the number of perforators on the outcomes of perforator flaps has been widely debated. This study aimed to compare the outcomes of single‐ and multiple‐perforator‐based free perforator flaps in free‐flap reconstruction.
Methods
We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov between January 2000 and June 2021 to identify studies that reported data on the outcomes of free perforator flaps. Two authors individually extracted data and performed quality assessment. Outcomes, including partial flap loss, total loss, fat necrosis, arterial insufficiency, venous insufficiency, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications, were evaluated.
Results
Thirty‐two studies with 2498 flaps were included in our analysis. No significant difference was found in the rates of partial loss and arterial insufficiency of flaps, hemorrhage and hematoma, wound dehiscence at recipient sites and donor site complications. However, the multiple‐perforator group showed significantly lower rates of total loss (relative risk [RR] = 1.08, 95% confidence interval [CI]: 0.78–1.79, p = .754), fat necrosis (RR = 1.79, 95% [CI]: 1.36–2.36, p = .000) and venous insufficiency (RR = 1.72, 95% CI: 1.07–2.79, p = .026) than the single‐perforator group.
Conclusion
The rates of total loss, fat necrosis and venous insufficiency in the multiple‐perforator group were lower than those in the single‐perforator group. Hence, we recommend that multiple perforators be included in the free perforator flap when appropriate, to yield better clinical outcomes in reconstruction.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>36086933</pmid><doi>10.1002/micr.30955</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-1612-7578</orcidid><orcidid>https://orcid.org/0000-0001-6276-0468</orcidid><orcidid>https://orcid.org/0000-0002-8320-2526</orcidid></addata></record> |
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| identifier | ISSN: 0738-1085 |
| ispartof | Microsurgery, 2023-02, Vol.43 (2), p.185-195 |
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| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Complications Dehiscence Fat Necrosis Free Tissue Flaps Hematoma Hemorrhage Humans Meta-analysis Necrosis Perforator Flap Plastic Surgery Procedures Postoperative Complications - etiology Quality assessment Quality control Reconstruction Wound dehiscence Wounds |
| title | Comparison of outcomes between single‐ and multiple‐perforator‐based free perforator flaps: A systematic review and meta‐analysis |
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