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Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta‐analysis
Author(s) -
Markiewicz Michael R.,
Bell R. Bryan,
Bui Tuan G.,
Dierks Eric J.,
Ruiz Ramon,
Gelesko Savannah,
Pirgousis Phillip,
Fernandes Rui
Publication year - 2015
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22471
Subject(s) - medicine , free flap , meta analysis , surgery , microsurgery , mandible (arthropod mouthpart) , radial artery , confidence interval , artery , botany , biology , genus
Background Free tissue transfer is commonly used in the reconstruction of post‐ablative defects of the mandible. Due to lack of statistical power, comparing the survival of various free flaps, even in large studies, is challenging. The purpose of this study was to perform a meta‐analysis comparing the survival of the most commonly used free flaps for mandibular reconstruction. Methods We searched PubMed, EMBASE, and SCOPUS for relevant studies. A meta‐analysis using the Peto one‐step odds ratio (OR) with 95% confidence intervals (CI) was used to compare the pooled survival of the most commonly used free flaps for mandibular reconstruction. Results Of the 25,303 studies reviewed, 17 were selected for data extraction. A total of 1,221 subjects received 1,262 free flaps. Sixty‐five free flaps failed. The pooled survival of all free flaps used for mandibular reconstruction was 94.8%. The deep circumflex iliac artery (DCIA) flap was associated with a seven‐fold increase in failure when compared to the radial forearm free flap (Peto OR 7.40; 95% CI 1.38, 39.75, P = 0.02). There was no difference in survival when comparing other commonly used free flaps. Conclusions The results of this study suggest that free flap reconstruction of the mandible is highly successful. With the exception of the increased survival of the radial forearm when compared to the DCIA, there is no difference in recipient site survival when comparing various free flaps for mandibular reconstruction. © 2015 Wiley Periodicals, Inc. Microsurgery 35:576–587, 2015.