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. 2018 Feb 8;6(2):e1651.
doi: 10.1097/GOX.0000000000001651. eCollection 2018 Feb.

A Systematic Review and Meta-analysis of Free-style Flaps: Risk Analysis of Complications

Youlei Qian  1 , Guangxue Li  1 , Huiran Zang  1 , Saisai Cao  1 , Yan Liu  1 , Kai Yang  1 , Lan Mu  1
Affiliations

A Systematic Review and Meta-analysis of Free-style Flaps: Risk Analysis of Complications

Youlei Qian et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Free-style flaps allow surgeons to overcome anatomical variations and raise perforator flaps wherever a pulsatile signal can be detected. We performed a systematic review and meta-analysis to identify the risk factors for complications and indications for free-style flaps in soft-tissue defect reconstructions.

Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases of MEDLINE, PubMed, ScienceDirect, and Cochrane Library were searched from January 1991 to January 2017 for original articles describing free-style flaps in soft-tissue defect reconstruction.

Results: A total of 17 articles met the inclusion criteria, representing 453 free-style flaps. The percentage of free-style flaps conducted after primary oncologic resection was 54.4% (246/453). Free-style flaps were mostly used in the head and neck region (35.5%), and most of them were designed as pedicled perforator flaps (96.7%). Complete flap survival was accomplished in 91.8% of the free-style flaps. Complications were found in 13.5% of cases, and 2 risk factors were identified: extremity defects (risk ratio, 2.39; P = 0.006) and single perforator flaps (risk ratio, 4.93; P = 0.002). No significant differences were found among the criteria including patients aged greater than 60 years, female gender, chronic etiology, flap size over 100 cm2, flap rotation, or perforator skeletonization.

Conclusions: Free-style flaps are both reliable and advanced forms of perforator flaps for use in soft-tissue defect reconstructions. Defects located on the extremities and flaps with single perforators are risk factors for flap failure and complications.

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Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram of literature search and selection process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Fig. 2.
Fig. 2.
Distribution of defection causes (presented with case numbers and percentage).
Fig. 3.
Fig. 3.
Forest plot for complication risk analysis of defects located on extremities.
Fig. 4.
Fig. 4.
Forest plot for complication risk analysis of flaps with single perforator.
Fig. 5.
Fig. 5.
Forest plot for complication risk analysis of patients’ age older than 60 years.
Fig. 6.
Fig. 6.
Forest plot for complication risk analysis of female gender.
Fig. 7.
Fig. 7.
Forest plot for complication risk analysis of chronic etiology.
Fig. 8.
Fig. 8.
Forest plot for complication risk analysis of flap size over 100 cm2.
Fig. 9.
Fig. 9.
Forest plot for complication risk analysis of flap rotation.
Fig. 10.
Fig. 10.
Forest plot for complication risk analysis of perforator skeletonization.
See this image and copyright information in PMC

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