title: A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications.
abstract: BACKGROUND
  Currently, increased interest in the perforator-pedicled propeller flap should not obscure the fact that it is, in reality, a complex procedure requiring experience and monitoring similar to free flaps. Through a meta-analysis, the authors aimed to identify the risk factors of perforator-pedicled propeller flap failure in lower extremity defects.
  
  
  METHODS
  The MEDLINE, PubMed Central, Embase, and Cochrane databases were searched from 1991 to May of 2014 for articles describing perforator-pedicled propeller flaps in the lower extremity. The study selection met the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Fixed-effects models were used.
  
  
  RESULTS
  Forty articles complied with the inclusion criteria, representing 428 perforator-pedicled propeller flaps. The most common cause was posttraumatic (55.2 percent). Most of the defects were at the distal third of the lower leg (45.6 percent). The arc of rotation was 180 degrees for 34.3 percent. Complications were found in 25.2 percent, including partial necrosis (10.2 percent) and complete necrosis (3.5 percent). Complete flap survival was found in 84.3 percent. The authors identified three significant risk factors: age older than 60 years (relative risk, 1.61; p = 0.03), diabetes (relative risk, 2.00; p = 0.02), and arteriopathy (relative risk, 3.12; p = 0.01). No significant results were found regarding smoking status other than a tendency (p = 0.06), acute cause (p = 0.59), posttraumatic cause (p = 0.97), distal third of the lower leg (p = 0.66), fascia inclusion (p = 0.70), and pedicle rotation greater than 120 degrees (p = 0.41).
  
  
  CONCLUSIONS
  Age older than 60 years, diabetes, and arteriopathy are significant risk factors of perforator-pedicled propeller flap complications in the lower extremity.
  
  
  METHODS
  Risk, IV.
authors.affiliation: Montpellier, Toulouse, Lyon, Amiens, and Paris, France From the Departments of Plastic and Reconstructive Surgery and Biostatistics and Medical Information, Lapeyronie University Hospital; the Department of Plastic and Reconstructive Surgery, Rangueil University Hospital; the Department of Plastic and Reconstructive Surgery, Edouard Herriot University Hospital; the Department of Plastic and Reconstructive Surgery, Nord University Hospital; and the Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital.
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
authors.forename: Christian
authors.initials: C
authors.lastname: Herlin
authors.forename: Ali
authors.initials: A
authors.lastname: Mojallal
authors.forename: Raphael
authors.initials: R
authors.lastname: Sinna
authors.forename: Benoit
authors.initials: B
authors.lastname: Ayestaray
authors.forename: Flavie
authors.initials: F
authors.lastname: Letois
authors.forename: Jean
authors.initials: J
authors.lastname: Pierre Chavoin
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garrido
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Grolleau
authors.forename: Benoit
authors.initials: B
authors.lastname: Chaput
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D017695:Soft Tissue Injuries / Q000175:diagnosis / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D014945:Wound Healing / Q000502:physiology*