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Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores

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Abstract

Background

Ischial sores have higher risks of recurrence and considered the most difficult to treat. There are mainly 2 groups of techniques used in ischial pressure sore reconstruction which are as follows: (1) fasciocutaneous and/or myocutaneous flaps (Fc/Mc) and (2) perforator flaps. The aim of this study is to determine the advantages of perforator flaps over Fc and/or Mc flaps in reconstruction of ischial pressure ulcers.

Methods

All articles published before April 2018 were investigated and searched for eligibility using the databases PubMed and Google Scholar. Eligible studies were determined according to inclusion and exclusion criteria. Recurrence rates, complication rates, and time of recurrences were assessed.

Results

A total of 15 studies with 279 patients and 305 flaps were identified and included in the final analysis. The overall recurrence rate of flaps was 6.31 (95% CI, 5.86 to 6.78; p < 0.001); complication rate of flaps was 3.06 (95% CI, 2.91 to 3.23; p < 0.001); and recurrence time of flaps was 0.77 (95% CI, 0.66 to 0.90; p < 0.001). The mixed-effects analysis results have revealed that there was no statistically significant difference between the perforator and the Fc/Mc groups (between-level) in terms of recurrence rates (p > 0.05), complication rates (p > 0.05), and time of recurrences (p > 0.05).

Conclusions

Perforator flaps mandate thorough pre-operative preparations, meticulous dissections, and long surgery times. There seem no advantage in applying perforator flaps in ischial pressure sore reconstructions in terms of complications and recurrences. Surgeons may prefer to perform straightforward procedures, such as myocutaneous flaps.

Level of evidence: Level IV, risk/prognostic, therapeutic study.

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Acknowledgments

The author wants to thank Cumali Uri for his devoted efforts in statistical analysis and to Dr. Bilsev Ince and Prof. Dr. Teoman Eskitaşçıoğlu for their kind editorial help.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Muğla Sıtkı Koçman University, Muğla, Turkey

    Mehmet Altıparmak

  2. Rekonstrüktif ve Estetik Cerrahi AD, Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi Plastik, Marmaris yolu üzeri. 48000, Muğla, Turkey

    Mehmet Altıparmak

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Correspondence to Mehmet Altıparmak.

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This study has been funded by the Muğla Sıtkı Koçman University Scientific Investigation Project Number 18/057.

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Mehmet Altıparmak declares that he has no conflict of interests.

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All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Altıparmak, M. Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores. Eur J Plast Surg 43, 211–218 (2020). https://doi.org/10.1007/s00238-019-01599-7

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  • DOI: https://doi.org/10.1007/s00238-019-01599-7

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