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A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects

Identification of Risk Factors for Complications

Bekara, Farid, M.D.; Herlin, Christian, M.D.; Mojallal, Ali, M.D., Ph.D.; Sinna, Raphael, M.D., Ph.D.; Ayestaray, Benoit, M.D.; Letois, Flavie, M.D.; Pierre Chavoin, Jean, M.D.; Garrido, Ignacio, M.D., Ph.D.; Grolleau, Jean Louis, M.D.; Chaput, Benoit, M.D.

Plastic and Reconstructive Surgery: January 2016 - Volume 137 - Issue 1 - p 314–331
doi: 10.1097/PRS.0000000000001891
Reconstructive: Lower Extremity: Outcomes Article
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Background: Currently, increased interest in the perforator-pedicled propeller flap should not obscure the fact that it is, in reality, a complex procedure requiring experience and monitoring similar to free flaps. Through a meta-analysis, the authors aimed to identify the risk factors of perforator-pedicled propeller flap failure in lower extremity defects.

Methods: The MEDLINE, PubMed Central, Embase, and Cochrane databases were searched from 1991 to May of 2014 for articles describing perforator-pedicled propeller flaps in the lower extremity. The study selection met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Fixed-effects models were used.

Results: Forty articles complied with the inclusion criteria, representing 428 perforator-pedicled propeller flaps. The most common cause was posttraumatic (55.2 percent). Most of the defects were at the distal third of the lower leg (45.6 percent). The arc of rotation was 180 degrees for 34.3 percent. Complications were found in 25.2 percent, including partial necrosis (10.2 percent) and complete necrosis (3.5 percent). Complete flap survival was found in 84.3 percent. The authors identified three significant risk factors: age older than 60 years (relative risk, 1.61; p = 0.03), diabetes (relative risk, 2.00; p = 0.02), and arteriopathy (relative risk, 3.12; p = 0.01). No significant results were found regarding smoking status other than a tendency (p = 0.06), acute cause (p = 0.59), posttraumatic cause (p = 0.97), distal third of the lower leg (p = 0.66), fascia inclusion (p = 0.70), and pedicle rotation greater than 120 degrees (p = 0.41).

Conclusion: Age older than 60 years, diabetes, and arteriopathy are significant risk factors of perforator-pedicled propeller flap complications in the lower extremity.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.

Coding Perspective for this article is on Page 329.This and Related “Classic” Articles Appear on Prsjournal.Com for Journal Club Discussions.

Montpellier, Toulouse, Lyon, Amiens, and Paris, France

From the Departments of Plastic and Reconstructive Surgery and Biostatistics and Medical Information, Lapeyronie University Hospital; the Department of Plastic and Reconstructive Surgery, Rangueil University Hospital; the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital; the Department of Plastic and Reconstructive Surgery, Nord University Hospital; and the Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital.

Received for publication October 21, 2014; accepted August 25, 2015.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received.

Benoit Chaput, M.D., Department of Plastic and Reconstructive Surgery, Rangueil University Hospital, Avenue du Professeur Jean Poulhes, 31 000 Toulouse, France, benoitchaput31@gmail.com

©2016American Society of Plastic Surgeons