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Raman et al. Plast Aesthet Res 2023;10:6 https://dx.doi.org/10.20517/2347-9264.2022.62 Page 7 of 16

Table 3. Infection rate reduction based on recipient and donor sites
Anatomical site Infection rate reduction (%)
Total 76.6 ± 1.4
Donor site
Groin 83.0 ± 3.2
Submental 79.5 ± 3.1
Omentum 87.9 ± 2.9
Supraclavicular 65.6 ± 9.5
Lateral thoracic N/A*
Appendicular N/A*
Ileocecal 100 ± 0
Jejunal mesenteric 100 ± 0
#
Unspecified † N/A
Intra-abdominal donor site 88.2 ± 2.8*
Extra-abdominal donor site 79.9 ± 2.2*
Recipient site
Upper extremity 86.8 ± 1.6
Lower extremity 73.3 ± 2.5
#
†Unspecified donor site in the neck region. Unclear infection rate reduction for this VLNT donor site. *P < 0.05.

Intra-abdominal vs. extra-abdominal
The donor sites were also grouped into intra-abdominal and extra-abdominal sites for further analysis.
Omental, jejunal mesenteric, ileocecal, and appendicular flaps were recorded as intra-abdominal, while
submental, groin, supraclavicular, lateral thoracic, and unspecified “neck” flaps were considered extra-
abdominal. The majority of patients (69.3%) received an extra-abdominal VLNT, while 21.5% received an
intra-abdominal flap [Table 2]. Investigations containing the remaining 9.1% of patients reported joint
results from intra- and extra-abdominal flaps.

On average, the infection rate decreased by 81.3% ± 2.9% after surgery, with significantly more infection
reduction for intra-abdominal flaps (88.2% ± 5.5 %) and extra-abdominal flaps (79.9% ± 4.3 %) (P = 0.009)
[Table 3].

Complications
Fifty-seven (86.4%) of 66 articles reported donor, recipient, or medical complications. Only 42 of these
articles were included in the meta-analysis since 15 investigations did not contain extractable data, either
due to not reporting the number of patients who experienced a complication or not differentiating
complications between various VLNT donor sites. There were no significant differences in donor site,
recipient site, and medical complication rates between VLNT donor sites (P = 0.50 ; P = 0.95; P = 0.29)
[Table 4]. There were also no statistically significant differences in donor site, recipient site, and medical
complication rates when comparing intra-abdominal and extra-abdominal VLNT donor sites
(P = 0.43; P = 0.92; P = 0.09).

Lateral thoracic donor sites had the highest donor site complication rate (12.2%), while the omental VLNT
donor site had the highest recipient site complication rate (8.6%) [Table 4].

Patient-reported outcomes
Sixteen articles (24.2%) reported validated patient-reported scale outcomes for VLNT patients, but only 11