Fasciocutaneous and/or myocutaneous flaps versus perforator flaps: systematic review and meta-analysis for reconstruction of ischial pressure sores

Abstract

Background Ischial sores have higher risks of recurrence and considered the most difficult to treat. There are mainly 2 groups of techniques used in ischial pressure sore reconstruction which are as follows: (1) fasciocutaneous and/or myocutaneous flaps (Fc/Mc) and (2) perforator flaps. The aim of this study is to determine the advantages of perforator flaps over Fc and/or Mc flaps in reconstruction of ischial pressure ulcers. Methods All articles published before April 2018 were investigated and searched for eligibility using the databases PubMed and Google Scholar. Eligible studies were determined according to inclusion and exclusion criteria. Recurrence rates, complication rates, and time of recurrences were assessed. Results A total of 15 studies with 279 patients and 305 flaps were identified and included in the final analysis. The overall recurrence rate of flaps was 6.31 (95% CI, 5.86 to 6.78; p < 0.001); complication rate of flaps was 3.06 (95% CI, 2.91 to 3.23; p < 0.001); and recurrence time of flaps was 0.77 (95% CI, 0.66 to 0.90; p < 0.001). The mixed-effects analysis results have revealed that there was no statistically significant difference between the perforator and the Fc/Mc groups (between-level) in terms of recurrence rates (p > 0.05), complication rates (p > 0.05), and time of recurrences (p > 0.05). Conclusions Perforator flaps mandate thorough pre-operative preparations, meticulous dissections, and long surgery times. There seem no advantage in applying perforator flaps in ischial pressure sore reconstructions in terms of complications and recurrences. Surgeons may prefer to perform straightforward procedures, such as myocutaneous flaps. Level of evidence: Level IV, risk/prognostic, therapeutic study.