title: Systematic Review and Meta-Analysis of Unconventional Perfusion Flaps in Clinical Practice.
abstract: BACKGROUND
  Although unconventional perfusion flaps have been in clinical use since 1975, many surgeons are still deterred from using them, because of some reports of high necrosis rates.
  
  
  METHODS
  The authors performed a systematic review and meta-analysis of all articles written in English, French, German, Spanish, and Portuguese on the clinical use of unconventional perfusion flaps and indexed to PubMed from 1975 until July 15, 2015.
  
  
  RESULTS
  A total of 134 studies and 1445 patients were analyzed. The estimated survival rate of unconventional perfusion flaps was 89.5 percent (95 percent CI, 87.3 to 91.3 percent; p < 0.001). Ninety-two percent of unconventional perfusion flaps (95 percent CI, 89.9 to 93.7 percent; p < 0.001) presented complete or nearly complete survival. Most defects mandating unconventional perfusion flap reconstruction were caused by trauma (63.6 percent), especially of the hand and fingers (75.1 percent). The main complication of all types of flaps was a variable degree of necrosis (7.5 percent of all unconventional perfusion flaps presented marginal necrosis; 9.2 percent and 5.5 percent had significant and complete necrosis, respectively). There was a positive correlation between the rate of postoperative infection and the need for a new flap (Pearson coefficient, 0.405; p = 0.001). Flaps used to reconstruct the upper limb showed better survival than those transferred to the head and neck or to the lower limb (p < 0.001).
  
  
  CONCLUSIONS
  Unconventional perfusion flaps show high survival rates and should probably be used more liberally, particularly in the realm of upper limb reconstruction.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Diogo
authors.initials: D
authors.lastname: Casal
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cunha
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Diogo
authors.initials: D
authors.lastname: Pais
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Paula
authors.initials: P
authors.lastname: Videira
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Joana
authors.initials: J
authors.lastname: Coloma
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Carlos
authors.initials: C
authors.lastname: Zagalo
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: Maria
authors.initials: M
authors.lastname: Angélica-Almeida
authors.affiliation: Lisbon, Portugal.|From the Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central; the Anatomy Department, the Centre for Chronic Diseases, and Global Health and Tropical Medicine, Nova Medical School, Faculdade de Ciências Médicas; the Department of Life Sciences, Faculdade de Ciências e Tecnologia, da Universidade Nova de Lisboa; and the Head and Neck Surgery Department, Lisbon Delegation of the Portuguese Institute of Oncology.
authors.forename: João Goyri
authors.initials: JG
authors.lastname: O'Neill
mesh_terms: D006801:Humans; D008866:Microsurgery / Q000379:methods*; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps