Perforator versus Non-Perforator Flap-Based Vulvoperineal Reconstruction-A Systematic Review and Meta-Analysis

Area of Science:

• Surgical oncology
• Reconstructive surgery
• Gynecologic oncology

Background:

• Advanced vulvoperineal cancer necessitates multidisciplinary treatment for oncological safety and quality of life (QoL).
• Reconstructive procedures in this region have high complication rates (approx. 30%).
• Perforator flaps aim to minimize functional deficits and donor site complications by preserving anatomical structures.

Purpose of the Study:

• To compare surgical outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction.
• To evaluate complication frequencies in patients undergoing these reconstructive techniques.

Main Methods:

• Systematic review of English-language studies published after 1980.
• Inclusion of randomized controlled trials, cohort studies, and case series.
• Random-effects meta-analysis to pool complication frequency data.

Main Results:

• 49 studies including 1840 patients met inclusion criteria.
• Overall short-term surgical complication rates were comparable between perforator (n=276) and non-perforator flaps (n=1564).
• A trend towards fewer complications was observed with perforator flaps; patient quality of life data was limited.

Conclusions:

• Vulvoperineal reconstruction with perforator flaps demonstrates promising results compared to non-perforator flaps.
• Further investigation into long-term outcomes and systematic patient quality of life assessment is warranted.
• Perforator flaps may offer benefits in vulvoperineal reconstruction, but more data is needed.