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Foppiani et al. Plast Aesthet Res 2023;10:xx https://dx.doi.org/10.20517/2347-9264.2022.137 Page 3 of 14

postoperative rates of complications following microsurgical breast reconstruction.

METHODS
[15]
This study protocol was prospectively registered with PROSPERO (Study # ID: CRD42022360392) . This
systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis
[15]
(PRISMA) statement guidelines .

Eligibility criteria
Criteria for included studies were defined as adult female patients who underwent autologous breast
reconstruction and were monitored with either oximetry or thermography. The full eligibility criteria are
accessible at PROSPERO and are as follows:

Inclusion criteria:
· Adult female patients
· Patients who underwent autologous breast reconstruction (microvascular)
· Patients who were monitored with oximetry or thermography
· Observational studies and clinical trials
· Case Series and Case Reports with greater than 15 patients
· Studies in English, French, and Spanish

Exclusion criteria:
· Editorials;
· Commentary reports;
· Case series/Case Report with < 15 patients
· Abstracts with no full text available
· Letters to the editors; · Animal studies
· Cadaveric Studies
· Studies where breast flap-related outcomes could not be identified

Search strategy
A comprehensive research review using subject headings, controlled vocabulary, and keywords was
conducted on 25 September, 2022, on MEDLINE (in Ovid), Web of Science, and the Cochrane Central
Register for studies published until 2021. Our full-text search strategy is accessible at PROSPERO.

Study selection
The search results were uploaded into the online systematic review program Covidence to conduct study
[16]
selection . Six independent reviewers performed a two-screening process for study selection. (Hernandez
Alvarez A, Valentine L, Weidman A, Devi K and Foppian JA). First, titles and abstracts were screened.
A third reviewer ( Foppian JA) moderated and if discordances were present, resolved the conflict. Next,
a full-text analysis was performed by four of the reviewers (Foppian JA, Hernandez Alvarez A, Valentine
L and Weidman A). If conflicts arose between reviewers, the third reviewer moderated a discussion
to come to a joint decision.

Data extraction/synthesis
Data extraction was guided by a predetermined checklist: first author’s last name, year of publication, total
sample size, gender, type of flaps, the device used for monitoring, monitoring protocol, identification of
threatened flaps, flap take back, rates of flap salvage, flap loss, complication including but not limited to:
congestion, ischemia, infection, necrosis, and hematoma, etiology of complication and treatment of
complication, time to identification of complications, and intervention for treatment of the complications.