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Cylinder et al. Plast Aesthet Res 2020;7:58 I http://dx.doi.org/10.20517/2347-9264.2020.85 Page 17 of 18

systematic review, we focused on the RFFF and ALT flaps used for shaft creation. There seems to be a
higher rate of PFL in the ALT cohort than the RFFF cohort (7.1% vs. 4.5%). While the rate of total flap
loss is historically higher in free flaps compared to pedicled flaps, PFL is not dictated by the type of flap,
but rather the dimensions and volume of tissue harvested on a finite number of perforators. Thus, while
total flap loss is attributed largely to technical failure, PFL may be considered more of a failure of design.
Moreover, the nature of free flaps allows more flexibility regarding vessel lie and pedicle inset, while
pedicled flaps may be more constrained three-dimensionally. When discussing PFL, future studies should
report on the above variables and strive to include all pertinent patient demographics, flap characteristics,
and outcomes. It is only through the identification of risk factors for PFL that appropriate strategies to
mitigate and treat this complication will become apparent.

DECLARATIONS
Authors’ contributions
Manuscript preparation, literature search, data review, creation of tables: Cylinder I
Data review, creation of tables: Heston A
Data review, creation of tables: Jedrzejewski B
Manuscript preparation, data review: Sikora Z
Manuscript preparation, data review: Peters B
Manuscript preparation, data review: Berli JU

Availability of data and materials
The authors confirm that the data supporting the findings of this study are available within the article.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
©The Author(s) 2020.

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