Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis
Abstract
:1. Introduction
2. Patients and Methods
2.1. Eligibility Criteria
2.2. Data Collection
2.3. Assessment of Methodological Quality and Study Outcomes
3. Results
3.1. Overview of Techniques
3.1.1. Anatomical Location
3.1.2. Defect and Flap Surfaces
3.1.3. Flap Types
3.1.4. Flap Procurement and Donor Site Closure
3.1.5. Complications and Revision Surgery
3.2. Risk Factors Analysis for Axillary Location
3.2.1. Based on the Flap Type
3.2.2. Based on the Type of Perforator
3.2.3. Based on the Type of Perforator among the Propeller Flaps
4. Discussion
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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---|---|---|---|---|
Elliot et al., 1992 [36] | United Kingdom | Case series | 4 | 17 |
Amarante et al., 1996 [37] | Portugal | Case series | 4 | 6 |
Schwabegger et al., 2000 [38] | Austria | Case series | 4 | 6 |
Geh et al., 2002 [39] | United Kingdom | Case series | 4 | 4 |
Guerra et al., 2004 [40] | United States | Case series | 4 | 2 |
Rehman et al., 2005 [41] | United Kingdom | Case series | 4 | 3 |
Sharma et al., 2006 [42] | India | Case series | 4 | 6 |
Rees et al., 2007 [43] | United Kingdom | Case report | 5 | 1 |
Dabernig et al., 2007 [44] | United Kingdom | Case series | 4 | 2 |
Laredo Ortiz et al., 2007 [45] | Spain | Case series | 4 | 2 |
Ayhan et al., 2008 [46] | Turkey | Case series | 4 | 3 |
Kishi et al., 2009 [47] | Japan | Case series | 4 | 4 |
Laredo Ortiz et al., 2010 [48] | Spain | Case series | 4 | 16 |
Unal et al., 2011 [49] | Turkey | Case series | 4 | 12 |
Busnardo et al., 2011 [50] | Brazil | Prospective cohort | 5 | 12 |
Sever et al., 2012 [51] | Turkey | Case series | 4 | 2 |
Hallock 2013 [52] | United States | Case series | 4 | 2 |
Egemen et al., 2013 [53] | Turkey | Case series | 4 | 11 |
Alharbi et al., 2014 [54] | France | Case series | 4 | 10 |
Wormald et al., 2014 [28] | United Kingdom | Prospective cohort | 2 | 15 |
Mehrotra 2015 [55] | India | Letter to the editor | 4 | NR |
Baghaki et al., 2015 [56] | Turkey | Case report | 5 | 1 |
Schmidt et al., 2015 [57] | Austria | Case series | 4 | 20 |
Haq et al., 2015 [58] | Pakistan | Case report | 5 | 1 |
Hoang et al., 2016 [59] | United States | Case report | 5 | 1 |
Ching et al., 2017 [60] | Australia | Case series | 4 | 4 |
Nail-Barthelemy et al., 2019 [61] | France | Case series | 4 | 13 |
Lakshmana Rao et al., 2018 [62] | India | Case series | 4 | 8 |
Elgohary et al., 2018 [63] | Egypt | Prospective cohort | 3 | 20 |
Marchesi et al., 2018 [64] | Italy | Case series | 4 | 12 |
Elboraey et al., 2019 [65] | Kuwait | Case series | 4 | 6 |
Sirvan et al., 2019 [66] | Turkey | Case series | 4 | 14 |
Rodriguez et al., 2019 [67] | Colombia | Case series | 4 | 2 |
Kim et al., 2020 [68] | Korea | Case report | 5 | 1 |
Virág et al., 2020 [69] | Romania | Case series | 4 | 21 |
Marchesi et al., 2021 [70] | Italy | Case series | 4 | 26 |
Case Series | Were There Clear Criteria for Inclusion in the Case Series? | Was the Condition Measured in a Standard, Reliable Way for All Participants Included in the Case Series? | Were Valid Methods Used for Identification of the Condition for All Participants Included in the Case Series? | Did the Case Series Have Consecutive Inclusion of Participants? | Did the Case Series Have Complete Inclusion of Participants? | Was There Clear Reporting of the Demographics of the Participants in the Study? | Was There Clear Reporting of Clinical Information of the Participants? | Were the Outcomes or Follow-Up Results of Cases Clearly Reported? | Was There Clear Reporting of the Presenting Site(s)/Clinic(s) Demographic Information? | Was Statistical Analysis Appropriate? |
---|---|---|---|---|---|---|---|---|---|---|
Elliot et al., 1992 [36] | no | NA | no | no | no | yes | no | yes | no | NA |
Amarante et al., 1996 [37] | no | NA | no | no | no | yes | no | yes | no | NA |
Schwabegger et al., 2000 [38] | no | no | no | yes | yes | no | no | yes | no | NA |
Geh et al., 2002 [39] | yes | NA | yes | no | no | yes | no | yes | yes | NA |
Guerra et al., 2004 [40] | yes | NA | no | yes | yes | no | no | no | no | NA |
Rehman et al., 2005 [41] | no | NA | no | no | no | yes | no | yes | no | NA |
Sharma et al., 2006 [42] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Rees et al., 2007 [43] | no | no | no | no | no | yes | no | no | no | NA |
Laredo Ortiz et al., 2007 [45] | yes | NA | no | yes | yes | yes | no | no | no | NA |
Ayhan et al., 2008 [46] | yes | NA | no | yes | yes | yes | no | no | no | NA |
Kishi et al., 2009 [47] | yes | NA | yes | no | no | yes | no | yes | no | NA |
Laredo Ortiz et al., 2010 [48] | yes | NA | yes | no | no | yes | no | yes | no | NA |
Unal et al., 2011 [49] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Sever et al., 2012 [51] | yes | NA | yes | yes | yes | yes | no | no | no | NA |
Hallock 2013 [52] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Egemen et al., 2013 [53] | yes | NA | yes | no | no | yes | no | yes | no | NA |
Alharbi et al., 2014 [54] | yes | NA | yes | yes | yes | yes | no | yes | yes | NA |
Mehrotra 2015 [55] | no | NA | no | no | no | no | no | no | no | NA |
Schmidt et al., 2015 [57] | yes | NA | no | yes | yes | yes | no | yes | no | NA |
Ching et al., 2017 [60] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Nail-Barthelemy et al., 2019 [61] | yes | NA | yes | yes | yes | yes | yes | yes | yes | NA |
Lakshmana Rao et al., 2018 [62] | yes | NA | yes | no | no | yes | no | yes | no | NA |
Marchesi et al., 2018 [64] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Elboraey et al., 2019 [65] | yes | NA | yes | yes | yes | yes | yes | yes | yes | NA |
Sirvan et al., 2019 [66] | yes | NA | yes | no | no | yes | no | yes | yes | NA |
Rodriguez et al., 2019 [67] | yes | NA | yes | no | no | yes | no | yes | no | NA |
Virág et al., 2020 [69] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Marchesi et al., 2021 [70] | yes | NA | yes | yes | yes | yes | no | yes | no | NA |
Cohort Studies | Were the Two Groups Similar and Recruited from the Same Population? | Were the Exposures Measured Similarly to Assign People to both Exposed and Unexposed Groups? | Was the Exposure Measured in a Valid and Reliable Way? | Were Found Confounding Factors Identified? | Were Strategies to Deal with Confounding Factors Stated? | Were the Groups/Participants Free of the Outcome at the Start of the Study (or at the Moment of Exposure)? | Were the Outcomes Measured in a Valid and Reliable Way? | Was the Follow up Time Reported and Sufficient to Be Long Enough for Outcomes to Occur? | Was Follow up Complete, and If Not, Were the Reasons to Loss Follow up Described and Explored? | Were Strategies to Address Incomplete Follow up Utilized? | Was Appropriate Statistical Analysis Used? |
---|---|---|---|---|---|---|---|---|---|---|---|
Busnardo et al., 2011 [50] | yes | yes | yes | no | NA | no | yes | yes | no | NA | yes |
Wormald et al., 2014 [28] | yes | NA | NA | no | NA | no | yes | yes | Unclear | Unclear | yes |
Elgohary et al., 2018 [63] | no | yes | yes | Unclear | Unclear | no | yes | yes | NA | NA | yes |
Value | % | |
---|---|---|
Articles | 36 | |
Patients | 286 | |
Flaps | 387 | |
Age (years) | ||
Articles including data | 32 | 88.9% (1) |
Mean +/− 95% CI | 35.6 +/− 0.91 | |
Range | 16–76 | |
Female sex | ||
Number of patients | 125 | 48.3% (1) |
Articles including data | 31 | 86.1% (1) |
Smoking | ||
Number of patients | 66 | 55% (1) |
Articles including data | 24 | 66.7% (1) |
HBP | ||
Number of patients | 5 | 7% (1) |
Articles including data | 8 | 22.2% (1) |
Diabetes | ||
Number of patients | 16 | 12.6% (1) |
Articles including data | 12 | 33.3% (1) |
BMI (kg/m2) | ||
Articles including data | 6 | 16.7% (1) |
Mean +/− 95% CI | 27.9 +/− 1.20 | |
Range | 18.17–45.7 | |
Overweight/obesity | ||
Number of patients | 63 | 67.7% (1) |
Articles including data | 9 | 25% (1) |
Location | ||
Articles including data | 36 | 100% (2) |
Axillary | 322 | 83.2% (2) |
Inguinal | 19 | 4.9% (2) |
Anogenital | 45 | 11.6% (2) |
Cervical | 1 | 0.3% (2) |
Hurley stage | ||
Articles including data | 12 | 33.3% (2) |
Mean +/− 95% CI | 2.8 +/− 0.0 | |
Range | 2–3 | |
Lateral surgical margin | ||
Articles including data | 32 | 88.9% (2) |
Affected skin | 142 | 37.5% (2) |
Surgical margin around affected skin | 77 | 20.3% (2) |
Hairy skin | 157 | 41.4% (2) |
Surgical margin around hairy skin | 3 | 0.8% (2) |
Deep surgical margin | ||
Articles including data | 31 | 86.1% (2) |
Affected area | 243 | 66.6% (2) |
Subcutaneous tissue | 5 | 1.4% (2) |
Subcutaneous tissue excluding fascia | 54 | 14.8% (2) |
Subcutaneous tissue including fascia | 44 | 12.1% (2) |
Surgical margin around affected area | 19 | 5.2% (2) |
Peri operative antibiotic therapy | ||
Number of flaps | 126 | 100% (2) |
Articles including data | 9 | 25% (2) |
Surface of flap (cm2) | ||
Articles including data | 15 | 41.7% (2) |
Mean +/− 95% CI | 128.3 +/− 11.3 | |
Range | 20–374 |
Location | Flaps (n) | Flaps (%) |
---|---|---|
Axillary | 322 | 83.2 |
Anogenital | 45 | 11.6 |
Inguinal | 19 | 4.9 |
Cervical | 1 | 0.3 |
Total | 387 | 100 |
Location | Flaps (n) | Flaps (%) |
---|---|---|
Total | 356 | 100 |
Propeller | 224 | 62.9 |
Advancement | 43 | 12.1 |
Peninsular | 36 | 10.1 |
Interpolation | 1 | 0.3 |
VY | 14 | 3.9 |
Keystone | 38 | 10.7 |
Location | Flaps (n) | Flaps (%) |
---|---|---|
Total | 58 | 15.1 |
Total necrosis | 2 | 0.5 |
Partial necrosis | 11 | 2.9 |
venous congestion | 7 | 1.8 |
Wound deshiscence | 21 | 5.5 |
Hematoma | 5 | 1.3 |
Seroma | 3 | 0.8 |
Infection | 8 | 2.1 |
Nerve Injury | 1 | 0.3 |
Type of Flap | Flaps (n) | Complications (n) | Complications (%) |
---|---|---|---|
Total | 322 | 48 | 14.9 |
Propeller | 183 | 37 | 20.2 |
Advancement | 35 | 5 | 14.3 |
Peninsular | 23 | 1 | 4.3 |
Interpolation | 1 | 0 | 0 |
Keystone | 18 | 2 | 11.1 |
VY | 10 | 0 | 0 |
NR | 52 | 3 | 5.8 |
Type of Perforator | Flaps (n) | Complications (n) | Complications (%) |
---|---|---|---|
Total | 322 | 48 | 14.9 |
TDAP | 146 | 25 | 17.1 |
PAP | 69 | 8 | 11.6 |
IAP | 24 | 4 | 16.7 |
CSAP | 10 | 0 | 0 |
LTAP | 9 | 0 | 0 |
SAAP | 0 | 0 | 0 |
LICAP | 0 | 0 | 0 |
NR | 64 | 11 | 17.2 |
Type of Perforator | Flaps (n) | Complications (n) | Complications (%) |
---|---|---|---|
Total | 195 | 39 | 20 |
TDAP | 110 | 21 | 19.1 |
PAP | 30 | 6 | 20.0 |
IAP | 6 | 1 | 16.7 |
CSAP | 10 | 0 | 0 |
LTAP | 2 | 0 | 0 |
SAAP | 0 | 0 | 0 |
LICAP | 0 | 0 | 0 |
NR | 37 | 11 | 29.7 |
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Vaillant, C.; Berkane, Y.; Lupon, E.; Atlan, M.; Rousseau, P.; Lellouch, A.G.; Duisit, J.; Bertheuil, N. Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis. J. Clin. Med. 2022, 11, 5813. https://doi.org/10.3390/jcm11195813
Vaillant C, Berkane Y, Lupon E, Atlan M, Rousseau P, Lellouch AG, Duisit J, Bertheuil N. Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis. Journal of Clinical Medicine. 2022; 11(19):5813. https://doi.org/10.3390/jcm11195813
Chicago/Turabian StyleVaillant, Camille, Yanis Berkane, Elise Lupon, Michael Atlan, Pascal Rousseau, Alexandre G. Lellouch, Jérôme Duisit, and Nicolas Bertheuil. 2022. "Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis" Journal of Clinical Medicine 11, no. 19: 5813. https://doi.org/10.3390/jcm11195813