The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review.

摘要: Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined impact perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and fasciocutaneous lower extremity. Methods PubMed, Scopus, Cochrane Central Register Controlled Trials were reviewed for literature examining from knee ankle, January 2000 through November 2018. The Preferred Reporting Items Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used. Results Thirty-six articles included quantitative analysis. Of 586 flaps, 365 skeletonized (60.1%) with 58 major (9.9%) 19 minor complications (3.2%). With skeletonization, overall reoperative rate higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) rotational 18.87, p = 0.004). complication also increased 2.60, p = 0.04). Notably, reduced rotated 90 degrees or more 0.21, p = 0.02). Reoperative distal third 14.08, p = 0.02), over 48 cm2 33.33, p = 0.01), length width ratios 1.75 7.52, p = 0.03) skeletonization. Skeletonization traumatic 2.87, p = 0.04) malignant 0.10, p = 0.01). Conclusion Pedicled, can reliable locoregional alternative defects. Though rate, rotation significantly reduced. suggests should be considered when large movements anticipated reduce that arise compression venous congestion.