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Meta-Analysis
. 2021 Aug;18(4):525-535.
doi: 10.1111/iwj.13552. Epub 2021 Mar 6.

A systematic review and meta-analysis of perforator flaps in plantar defects: Risk analysis of complications

Wei Zhang  1 , Xinyi Li  1 , Xiaojing Li  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis of perforator flaps in plantar defects: Risk analysis of complications

Wei Zhang et al. Int Wound J. 2021 Aug.

Abstract

The purpose of this study was to identify the risk factors for complications of perforator flaps in plantar reconstruction. A systematic review was performed by searching the PubMed, Cochrane Library, MEDLINE, and EMBASE databases from their inception date up to October 2020. Only studies on reconstructing plantar defects with perforator flaps were included, and specific data were required for each patient in the included studies. A total of 14 studies involving 111 flaps were identified and included in the meta-analysis. Our meta-analysis identified two risk factors for postoperative complications: flap size over 50 cm2 (risk ratio [RR] = 3.12; P = .02), diabetes mellitus foot (RR = 3.26; P = .03). No significant differences were found regarding heel defects (P = .34), single perforator (P = .57), age older than 60 years (P = .19), chronic aetiology (P = .13), trauma (P = .33), tumour resection (P = .60), ulcer (P = .84), and burn (P = .76). Although more high-quality studies with adequate sample sizes are needed, this meta-analysis indicated that flap size over 50 cm2 and diabetes mellitus foot were significant risk factors for postoperative complications of perforator flaps in plantar reconstruction.

Keywords: complication; meta-analysis; perforator flap; plantar defect; risk factor.

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Conflict of interest statement

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the selection process for eligible studies
FIGURE 2
FIGURE 2
Distribution of causes (in percent)
FIGURE 3
FIGURE 3
Forest plot for complication risk analysis of flap size over 50 cm2
FIGURE 4
FIGURE 4
Forest plot for complication risk analysis of chronic aetiology
FIGURE 5
FIGURE 5
Forest plot for complication risk analysis of diabetic foot
FIGURE 6
FIGURE 6
Forest plot for complication risk analysis of heel defects
FIGURE 7
FIGURE 7
Forest plot for complication risk analysis of single perforator
FIGURE 8
FIGURE 8
Forest plot for complication risk analysis of age older than 60 years
FIGURE 9
FIGURE 9
Funnel plot for complication risk analysis of flap size over 50 cm2
FIGURE 10
FIGURE 10
Funnel plot for complication risk analysis of diabetic foot
See this image and copyright information in PMC

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