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Raman et al. Plast Aesthet Res 2023;10:6 https://dx.doi.org/10.20517/2347-9264.2022.62 Page 9 of 16

Figure 2. Forest plot depicting average infection rate reduction for each of these studies. Studies that did not report the number of
preoperative and postoperative infections were excluded from this plot.

Lymphedema 27 (ULL-27) questionnaire, the Lymphedema Life Impact Scale version 2 (LLISv2), and the
Patient Scar Assessment Questionnaire (PSAQ), which were all utilized by one investigation each. The pain
and heaviness visual analog scale (VAS) was used in two studies.

Submental flaps had the largest number of articles that included patient-reported outcomes, with 6 articles.
This is followed by 5 articles, each reporting on patient-reported outcomes for omental and groin flaps.
There were no studies that addressed patient-reported outcomes in patients who received appendicular,
ileocecal, and jejunal mesenteric flaps.

LYMQOL results were analyzed and compared. There are 2 versions of the LYMQOL scale, one for upper
extremity and one for lower extremity [22,23] . Overall, there was an improvement in each of the 5 LYMQOL
domains: symptoms, body image/appearance, function, mood, and overall quality of life, after VLNT
[Table 5]. When conducting a meta-analysis, studies containing intervention groups involving multiple
donor sites were excluded. Based on this consideration, only studies addressing submental and omental
VLNT could be included for analysis [Figure 3]. No statistically significant difference was found when
comparing each LYMQOL domain for omental and submental VLNT (P = 0.06).