Abstract
BackgroundFlaps are increasingly popularized in reconstructive surgery and there is need to test and increase their reliability. Color Doppler ultrasound has been stated to be valuable in flap planning. The aim of this study was to conduct a systematic review and meta-analysis of the literature of Color Doppler ultrasound targeted pedicled perforator flaps and provide information on outcomes and complication rates.MethodA systematic review and meta-analysis were conducted for articles published until April 2017 in PubMed and Embase. We aimed to include randomized clinical trials, meta-analysis, prospective studies, case-control studies, and cohort studies written in English. We included studies where CDU was used to identify the perforator(s) prior to surgery. We evaluated the quality of the included studies using checklists recommended by the Cochrane group.ResultsFrom the initial 219 studies, only 12 studies using Color Doppler targeted pedicled perforator flaps in 252 cases met the inclusion and exclusion criteria. Eleven of these were case series and one a prospective study. The incidence of major complications was 8% (21/252) and minor complications was 14%, comprising of mostly necrosis 8% (24/252) and venous congestion 8% (21/252).ConclusionsThe reconstructive success rate following pedicled perforator flap reconstruction targeted by CDU appears to be high and the procedure provides a wide scope of applications and margin of safety. It is evident that the risk of venous congestion is 11 times greater in the lower extremities than the truncus, a finding that needs further attention in future studies.Level of Evidence: Level IV, risk/prognostic study
Highlights
Knowledge about perforator anatomy has led to an increased use of pedicled perforator flaps for reconstruction throughout the body [1]
The studies described 252 color Doppler ultrasonography (CDU) targeted pedicled perforator flaps used for reconstruction in 246 patients; 72 male, 153 female, and 21 gender not described [3, 9–19]
The study revealed an 11 times greater risk of venous congestion when pedicled perforator flaps were raised in the extremities compared to the trunk
Summary
Knowledge about perforator anatomy has led to an increased use of pedicled perforator flaps for reconstruction throughout the body [1]. Pedicled perforator flaps allow the surgeon to relocate local tissue and facilitate a simple reorganization, which enables an optimal cosmetic and functional reconstructive outcome. They provide a fast and simple, single-stage solution and offer an alternative to microsurgery or skin graft [2]. Handheld Doppler and color Doppler ultrasonography (CDU) have been shown to be useful to identify perforators and aid in the planning of flap reconstructions [2]. The aim of this study was to conduct a systematic review and meta-analysis of the literature of Color Doppler ultrasound targeted pedicled perforator flaps and provide information on outcomes and complication rates. We included studies where CDU was used to identify the perforator(s) prior to surgery. We evaluated the quality of the included studies using checklists recommended by the Cochrane group
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