A Meta-Analysis Study: Risk Factors of Total Flap Necrosis in Microsurgery

Abstract

Background:Free flap surgery allows closure of the defect with excellent results. Developed knowledge and skills lead to higher success rates. Failure to do so in the form of total flap necrosis can cause burdensome problems for both the surgeon and the patient. We performed a meta-analysis to analyze several risk factors for total flap necrosis in free flap surgery. Age, gender, diabetes mellitus (DM), hypertension (HT), duration of surgery, blood transfusions, and intraoperative intravenous fluids are among them. Methods:This study was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. We used the PubMed, Science Direct, Proquest, and Web of Science databases from January 2019 to December 2020. The selected articles described free flaps and included the number of cases according to variables and the incidence of total flap necrosis. Results:We found thirteen articles met the criteria for meta-analysis. A total of 2,063 free flaps were documented, and 65.9% were male patients. Most of the defects were caused by malignancies (75.4%). The most common location was the head and neck (72.7%). Free flaps from the lateral circumflex femoral system and the radial forearm are the two most common types of free flaps. The overall success of the free flap in this study was 93.45%, while the failure rate was 6.55%. Total necrosis was found in 23% of all postoperative complications. There were no significant differences in criteria for old age (> 60 years), female gender, DM, HT, and duration of surgery. Transfusions or intraoperative fluid administration cannot be concluded from this research. Conclusion:The causes of free flap failure are multifactorial and no absolute contraindications to surgery are mentioned in the literature. Some of the factors analyzed in this study were not significant as the risk of total free flap necrosis but could lead to other surgical or medical complications. However, further studies are needed.