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A Systematic Review of Minimally Invasive Techniques for Perfusion Optimization of Flaps
Micaela Tobin, BA; Charlotte Thomas, BS; Tricia Raquepo, BA; Mohammed Yamin, BS; Audrey Mustoe, BA; Agustin Posso, MD; Jose Foppiani, MD; Ryan P. Cauley, MD, MPH
Department of Plastic and Reconstructive Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
Background: This systematic review aims to assess the literature on preconditioning and angiographic delay techniques to better understand the potential applications of these procedures in preventing ischemia-related complications.
Methods: A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were studies that included patients undergoing any flap-based reconstruction who were treated with minimally invasive delay.
Results: Five studies were included (angiographic delay n=143, heat preconditioning n=141, ischemic preconditioning n=60) which examined minimally invasive methods for perfusion optimization. Angiographic results demonstrated that in comparison to historical controls, the rate of flap necrosis in study groups was less than that of non-delayed flaps (27%), and comparable to that of traditional surgical ligation (11%). There were no significant differences (P=1.0) found with ischemic preconditioning compared to controls, whereas heat preconditioning led to reductions (26% vs. 35%) in flap necrosis and necrosis requiring surgical intervention (11% vs. 17%).
Conclusion: Angiographic embolization of flaps reduces the risk of flap necrosis. Heat and ischemic preconditioning are other potential alternatives that can increase flap survival. Further research investigating interventions for preoperative conditioning is needed to optimize surgical outcomes.
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