Abstract
Introduction Free-flap outcomes in lower extremity reconstruction carry the lowest anastomotic
success rates compared with other anatomical sites. Despite their advantages over
traditional nonperforator flaps, free perforator flaps have only recently become established
in this area due to the additional challenges faced. It is therefore crucial to assess
the anastomotic outcomes of perforator and nonperforator free flaps.
Methods We performed a single-center retrospective cohort study and combined this with a
meta-analysis of the relevant literature. We evaluated three flap anastomotic outcomes:
reexploration, operative salvage, and flap failure rates.
Results Between January 2010 and June 2015, our center managed 161 patients who underwent
lower extremity free-flap reconstruction, which included 76 perforator flaps and 85
nonperforator flaps. The perforator flaps had higher reexploration rates compared
with the nonperforator flaps, but this was not statistically significant (18.4 and
10.6%; p = 0.18). Perforator flaps had a higher flap salvage rate but were not statistically
significant (78.6 and 22.2%; p = 0.374). Lastly, although not statistically significant, perforator flaps had a
lower rate of complete failure due to anastomotic complications (3.9 and 8.2%; p = 0.336). The meta-analysis included 12 studies (inclusive of the index study) and
found no statistical difference in all three outcomes.
Conclusion Our meta-analysis is the first reported study and serves as an indication that free
perforator flaps in lower extremity are as reliable as their traditional nonperforator
counterparts. This does come with the prerequisite appreciation of the anatomical
variations, the delicate handling of these flaps, and a low threshold for reexploration.
Keywords
lower extremity - perforator flap - meta-analysis
