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Meta-analysis reports increased free flap failure rates in diabetic patients, suggesting important surgical considerations.
Background: Diabetes mellitus (DM) is a comorbid condition involved in numerous postoperative complications. Existing published reviews exploring the link between DM and free flap failure are not based on an essentially comprehensive approach; therefore, they do not allow us to ascertain to what extent free flap surgery is affected by DM. Our meta-analysis uses an exhaustive approach in order to determine whether and to what degree DM is associated with higher rates of free flap failure, with a focus on the anatomic region being reconstructed. Materials and methods: The search engines PubMed, Embase, and Web of Science were browsed using specified terms. The studies’ characteristics, including patient demographics and study outcomes, were recorded and analyzed. Results: Of the 1103 articles identified by the literature search, 358 articles met the inclusion criteria, among which 97 articles had extractable data pertaining to the outcome of interest. Another five articles were added from bibliographic searches, resulting in a total of 102 articles relevant to our meta-analysis. Of these articles, 12 articles were excluded from the main statistical analysis to avoid overlapping populations. Thus, the main statistical analysis comprises 90 articles representing 26 128 flaps, including 4261 flaps in diabetic patients. The flap failure rate is 3.9% overall, with a higher rate in diabetic patients (6.5% in diabetic patients vs 3.4% in non-diabetic patients, RR = 2.29; 95% CI = [1.82, 2.88]). Conclusion: The present meta-analysis clearly establishes a correlation between DM status and free flap failure that is both statistically and clinically significant (RR = 2.29, absolute risk difference of 3.1%). Further investigation is needed, notably by using population-wide databases, to provide a more precise insight into this correlation and account for confounding variables. This could help shape relevant guidelines for performing flap surgery in DM patients.
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Houdelette et al. (2026) studied this question.
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