Analysis of risk factors for complications of perforator propeller flaps used for soft tissue reconstruction after malignant tumor resection: A systematic review and meta‐analysis

Abstract

Background: Perforator propeller flaps (PPFs) have been widely used due to their numerous advantages; however, they were also associated with various complications. Herein, we analyzed the risk factors for complications of PPFs used for soft tissue reconstruction after malignant tumor resection. Methods:We searched databases for articles on soft tissue reconstruction using PPFs after malignant tumor resection published between January 1991 and April 2021. Studies were selected according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Fixed effects models and relative risks were used for data analysis. Funnel plots and Begg's test were used to evaluate publication bias.Results: Twenty-six articles met the inclusion criteria. Complications were found in 24.7% of all patients. The four significant risk factors were age equal or older than 60 years (pooled relative risk, 1.83; p = .04), smoking (pooled relative risk, 2.32; p = .03), diabetes (pooled relative risk, 2.59; p = .01) and radiotherapy (pooled relative risk, 2.09; p = .01). Hypertension, defects located in the extremities, flap size equal or greater than 100 cm 2 , and pedicle rotation equal or greater than 120 degrees were not significant risk factors for complications. No publication bias was found in the included articles. Conclusion:Age equal or older than 60 years, smoking, diabetes and radiotherapy are four risk factors for complications when PPFs are used to reconstruct soft tissue defects resulting from malignant tumor resection.

Repair of Asian nasal subunit defects using nasolabial perforator flaps: A retrospective study

“…One of the venous congestive flaps progressed to necrosis, which could be attributed to the perforator damage, and finally, a secondary skin graft was performed for repair. A meta‐analysis reported that age ≥60 years, smoking, diabetes, and radiotherapy are the risk factors associated with complications in flap reconstruction 22 . Herein, we did not find any risk factors for complications due to the low complication rate (6.6%).…”

“…19 The application of a nasolabial perforator flap makes primary surgery available. About 65.5% of defects in this study have The common postoperative complications of perforator flaps include venous congestion and partial necrosis, 22 and the former occurred in 4.9% of flaps in the present study. One of the venous congestive flaps progressed to necrosis, which could be attributed to the perforator damage, and finally, a secondary skin graft was performed for repair.…”

“…A meta-analysis reported that age ≥60 years, smoking, diabetes, and radiotherapy are the risk factors associated with complications in flap reconstruction. 22 Herein, we did not find any risk factors for complications due to the low complication rate For all patients who undergo surgery with a nasolabial perforator flap, it is suggested that the changes in flap color and temperature should be kept under close observation. Using vasoactive drugs or relieving venous obstruction needs to be conducted at once, in case of the flap arterial supply or venous reflux is blocked.…”

Islanded SCIP flap after sarcoma resection: a novel approach for Mons pubis defects

“…Flap complications most commonly result from vascular insufficiency and, given the small diameter and length of the perforators in SCIP flaps, expertise in perforator dissection is vital to avoid venous congestion on flap inset or inadvertent perforator arterial injury. 6,7 Higher wound complication rates have been reported in smokers, diabetics, patients over the age of 60 years and recipients of pre-operative radiotherapy. 7 Our patients' only risk factor was her neoadjuvant radiotherapy and when planning SCIP procedures the individuals risk profile should be carefully considered.…”

“…6,7 Higher wound complication rates have been reported in smokers, diabetics, patients over the age of 60 years and recipients of pre-operative radiotherapy. 7 Our patients' only risk factor was her neoadjuvant radiotherapy and when planning SCIP procedures the individuals risk profile should be carefully considered.…”