Introduction
Methods
Literature search
Inclusion criteria
First authors, year, location (reference) | Information regarding CDU | Number of flaps | Type/location of flaps | Arc of rotation | Size of flap | Complications | |
---|---|---|---|---|---|---|---|
Major | Minor | ||||||
Zang 2015 | Doppler ultrasound probe was used to identify at least two large perforators adjacent to the defects at different intercostal spaces. Then, the one with the most prominent Doppler signals was selected as the preferred supply for the flap. | 9 | Truncus: 1 DICAP 4 DLICAP 3 LICAP 1 AICAP | 4 = 150° 5 = 180° | 6 × 6 cm–30 × 20 cm | 2 flaps partial necrosis that needed repair with AICAP propeller flaps | 1 flap marginal necrosis (2 cm) |
Hamdi 2015 | No information | 31 | Truncus: 18 TDAP 10 MS-LD 3 ICAP | No information | Length: 16–25 cm Width: 6–10 cm Average size: 20 × 8 cm | Partial flap necrosis occurred in 2 cases. Both necessitated a surgical debridement and direct closure. | A small skin slough occurred in one TAP flap that healed spontaneously. Minor wound dehiscence in the donor site occurred in 2 patients (6%). 4 flaps experienced venous congestion. |
Gravannis 2006 | All measurements were performed by the same observer using an ATL 3500 (Philips, Bothell, WA, USA) ultrasound machine equipped with a 5-MHz and 7.5-MHz linear color Doppler transducer. | 11 | Truncus: 4 ALT Lower limb: 7ALT | 180° | Length: 15–22 cm Width: 8–11 cm | All flaps survived completely, resulting in excellent functional and esthetic results. | 1 patient with slightly limited range of motion. 2 patients with muscle weakness that resolved after 6 months. |
Innocenti 2015 | No information | 14 | Upper limb: 14 radial forearm flap | 180° | No information | 1 case used for thenar eminence resurfacing developed necrosis and needed salvage with kite flap. | 2 patients with venous congestion that relieved spontaneously, 1 patient with epidermolysis. |
Tos 2011 | No information | 22 | Lower limb: 6 peroneal artery perforator 13 posterior tibial artery perforator 1 genicular artery perforator 1 lateral circumflex artery perforator 1 deep femoral artery perforator | 80°–180° | 3 × 5 cm–12 × 25cm | 1 flap necrosis of 50% treated with skin graft, 1 flap necrosis 80%, and 1 diabetic patient with epidermolysis that needed skin graft | 5 patients had a limited superficial epidermolysis for venous congestion that resolved spontaneously. 3 patients showed transient venous congestion of the flap. Prolonged leg edema with spontaneous resolution was observed in a patient with a large propeller flap covering an Achilles tendon allograft. |
Pignatti 2007 | No information | 6 | Lower limb: No detailed description on perforator origin | 2 × 90°, 2 × 135°, and 2 × 180° | 8 × 9 cm–25 × 12cm | None | One flap with small superficial necrosis of the tip, due to venous congestion because of inclusion in the design of an already scarred tissue at the tip of the flap. One other patient with a transient venous congestion was observed that resolved spontaneously. |
Gunnarson 2015 | Used a BK Medical color Doppler ultrasonographer with a 10–12 MHz linear transducer. The settings were set for small peripheral vessels and low flow velocity to enable detection of flow in the perforators. | 17 | 12 Upper limb 13 Lower limb 9 Truncus No detailed description on perforator origin | 21 × 90°–13 × 180° | 1.5 × 3 cm–12 × 22 cm | None | Minor complications were registered in 4/17 (24%); marginal necrosis was significant in 4 cases, however never more than 10% of the total flap size. |
Dong 2014 | No information | 20 | Lower limb: 15 peroneal artery perforator 5 posterior tibia artery perforator flap | 180° | 5 cm × 11 cm–12 cm × 28 cm | None | 1 patient had a venous crisis in the 24 h postoperatively, which responded to removal of some of the sutures and drainage of blood. |
Jacobs 2015 | No information | 99 | Truncus: 99 TAP | No information | 7 × 21cm–11 × 37cm | 1 hematoma, 2 venous congestion that needed surgical intervention and partial flap necrosis in 7. | 14 patients with minor complications not described further. |
Moscatiello 2007 | No information | 6 | Lower limb: 6 ALT perforator | 180° | No information | 1 flap with partial necrosis > 20% and the defect was covered with medial gastrocnemius flap | None |
Umemoto 2009 | No information | 4 | Lower limb: 4 sural artery perforator | No information | 4 × 6 cm–10 × 20 cm | None | None |
Jakubietz 2014 | No information | 7 | Lower limb: 3 posterior tibial artery perforator 1 anterior tibial artery perforator 3 peroneal artery perforator | 90°–180° | 4 × 7 cm–5 × 24 cm | In 1 patient, a noninsulin-dependent diabetic smoker, tip necrosis became apparent 4 days postoperatively. Debridement of the distal part of the flap, negative pressure therapy, and skin graft. In 1 patient with peripheral vascular disease developed superficial epidermolysis in both tips of flap, which also required skin grafting 10 days after the first surgery. | None |
Quality assessment of the studies
Article authors | Quality appraisal | ||||||||
---|---|---|---|---|---|---|---|---|---|
Study objectivea | Study designb | Study populationc | Interventiond | Outcome measurese | Statistical analysisf | Results and conclusionsg | Competing interests and sources of supporth | Total | |
Zang 2015 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 10 |
Hamdi 2015 | 1 | 0 | 1 | 1 | 1 | 1 | 3 | 0 | 8 |
Gravannis 2006 | 1 | 0 | 1 | 1 | 1 | 1 | 3 | 0 | 8 |
Innocenti 2015 | 0 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 9 |
Tos 2011 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 10 |
Gunnarson 2014 | 1 | 0 | 1 | 1 | 1 | 1 | 3 | 1 | 9 |
Dong 2014 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 10 |
Jacobs 2015 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 10 |
Moscatiello 2007 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 0 | 9 |
Umemoto 2009 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 0 | 9 |
Pignatti | 1 | 0 | 1 | 1 | 1 | 1 | 3 | 0 | 8 |
Jakubietz 2014 | 1 | 0 | 1 | 1 | 1 | 1 | 4 | 1 | 10 |