Free versus perforator‐pedicled propeller flaps in lower extremity reconstruction: What is the safest coverage? A meta‐analysis

Bekara, Farid; Herlin, Christian; Somda, Serge; Runz, Antoine De; Grolleau, J L; Chaput, Benoît

doi:10.1002/micr.30047

Cited by 104 publications

(134 citation statements)

References 85 publications

(112 reference statements)

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“…A recent systematic review has shown that the overall failure rate and complication rate were similar to that of free tissue transfer, whereas partial necrosis of PPFs was more prevalent at 7% compared with 2.7% in free flaps. 14 It is important to realize the limitations of these flaps in the setting of lower limb trauma, they do not strictly represent the surgical panacea. In our practice, we make a balanced assessment based on the extent of trauma against bringing in free tissue on a patient-bypatient basis.…”

Section: Discussionmentioning

confidence: 99%

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Summary Background: The use of pedicled perforator flaps provides an alternative to free tissue transfer for lower limb reconstruction. We use computer-aided image analysis to investigate the versatility of pedicled perforator flaps for the reconstruction of lower limb defects. Patients and methods: Between April 2007 and April 2011, a case series of 61 patients with wounds of the lower extremity from knee to ankle were reconstructed with pedicled perforator flaps. We performed 16 pedicled reverse-flow anterolateral thigh (RF-ALT) flaps, 8 pedicled medial sural artery perforator (MSAP) flaps, 26 pedicled peroneal artery perforator (PAP) flaps, and 11 pedicled posterior tibial artery perforator (PTAP) flaps. Digital planimetry of defects covered was analyzed and the "efficiency" of each flap was calculated, which allowed the assessment of the merits of each flap in the management of lower limb defects. Results: Flaps healed primarily in 82% of cases (50/61). Approximately 50% of the secondary donor sites required skin grafting. Complications requiring secondary surgery occurred in 18% (11/61) of the cases. Six required secondary skin grafting (10%). One RF-ALT flap was converted into a free flap, one PAP required arterial supercharging, and three pedicled RF-ALT flaps required venous supercharging. Image analysis showed that these pedicled perforator flaps could cover 75% of the surface area of the lower leg. The higher length of perforator allowed for greater "flap efficiency" and better versatility of tissue cover.

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Section: Discussionmentioning

confidence: 99%

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Wong

Deek

Hsu

et al. 2017

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…With regard to flap selection for reconstruction of the foot and ankle, Bekara et al agree that the success of free flaps and pedicled flaps in reality appears similar [28]. Gir et al believe that pedicled perforator flap use is a safe and reliable procedure for reconstructing soft tissue defects [29].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Cui

Maharjan

et al. 2016

PLoS ONE

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ObjectiveThe purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle.MethodsThis was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate. The relationship between postoperative wound infection and risk factors was also analyzed using a logistic regression model.ResultsThe overall flap survival rate was 85.42%. The necrosis rates of free flaps and pedicled flaps were 5.26% and 20.69%, respectively. According to the Cox regression model, flap type (hazard ratio [HR] = 2.592; 95% confidence interval [CI] (1.606, 4.184); P < 0.001) and postoperative wound infection (HR = 0.266; 95% CI (0.134, 0.529); P < 0.001) were found to be statistically significant risk factors associated with flap necrosis. Based on the logistic regression model, preoperative wound bed inflammation (odds ratio [OR] = 11.371,95% CI (3.117, 41.478), P < 0.001) was a statistically significant risk factor for postoperative wound infection.ConclusionFlap type and postoperative wound infection were both independent risk factors influencing the flap survival rate in the foot and ankle. However, postoperative wound infection was a risk factor for the pedicled flap but not for the free flap. Microvascular anastomosis is a major cause of free flap necrosis. To reconstruct complex or wide soft tissue defects of the foot or ankle, free flaps are safer and more reliable than pedicled flaps and should thus be the primary choice.

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“…[16] In propeller flaps, because of pedicle bending, torsion partial/ total flap failure or venous problems can be observed. [17] Bekara et al [18] compared pedicled perforator flaps with free flaps in the reconstruction of the lower extremity and observed similar complications with both flaps. For the reconstruction of dorsal leg defects, the most appropriate flap was suggested to have a low donor site morbidity and for which the surgeon is more experienced.…”

Section: (A) (B) (C) (D)mentioning

confidence: 98%

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

Yıldırım

İğde²,

Öztürk³

et al. 2017

Ulus Travma Acil Cerrahi Derg

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Shotgun injury is a trauma that leads to soft tissue defects, in which important structures such as the tendon and bone are exposed with fractures in the distal lower extremity. Because this region has insufficient soft tissue support, local flap options are highly limited. Although the most suitable options are free or perforator flaps for contemporarily reconstructing that region; owing to such highenergy traumas, the available local flaps are becoming more suitable. Besides having various advantages, bipedicled flaps are commonly used for reconstructing small-and medium-sized lower extremity defects. This study aimed to discuss the use of a delayed bipedicled flap, which has not been previously described in the literature.

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Free versus perforator‐pedicled propeller flaps in lower extremity reconstruction: What is the safest coverage? A meta‐analysis

Cited by 104 publications

References 85 publications

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Versatility and “flap efficiency” of pedicled perforator flaps in lower extremity reconstruction

Reconstruction of the Foot and Ankle Using Pedicled or Free Flaps: Perioperative Flap Survival Analysis

Delayed bipedicled flap: An alternative and new method for reconstruction of distal leg defect after gunshot trauma: A case report and review of the literature

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