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Figure 1. Systematic Reviews and Meta-analysis (PRISMA) guidelines flow diagram.

variance among the studies. Salgaretto et al., Kumbasar et al., and Koolen et al. recorded measurements
continuously for a minimum of two days after the conclusion of the procedure, providing a continuous
record of tissue oxygenation [28,31,32] . The remaining studies, meanwhile, opted for interval readings, though
the specific timing of these readings differed slightly between studies [Table 2].

Meta-analysis of complications [Table 3]
The pooled prevalence of complication-related outcomes was calculated through a meta-analysis random
effects model of proportion. The pooled prevalence of flaps determined to be threatened was 0.05 (95%CI
0.03-0.10) for studies using oximetry and 0.10 (95%CI 0.02-0.11) for those using thermography
[Supplementary Digital 1]. In studies using oximetry, the pooled prevalence of partial flap loss was 0.01
(95%CI 0.00-0.02) and 0.00 (95%CI 0.00-0.01) for complete flap loss. In those using thermography, the
pooled prevalence of partial flap loss was also 0.01 (95%CI 0.00-0.73) and 0.00 (95%CI 0.00-1.00) for
complete loss. With regards to the rate of flap salvage, the pooled prevalence of salvage in studies using
oximetry was 0.06 (95%CI 0.03-0.11) compared to 0.23 (95%CI 0.14-0.35) in those using thermography,
indicating that thermography was superior in facilitating salvage to compromised flaps [Supplementary
Digital 2]. The pooled prevalence of the rate of return to the operating room was 0.05 (95%CI 0.03-0.09) for
studies using oximetry and 0.01 (95% CI 0.00-0.73) for thermography [Supplementary Digital 3]. Further, in
studies using postoperative oximetry, the pooled prevalence rates of the remaining flap complications