Outcomes of free flap reconstruction for mandibular ORN: Systematic review and meta-analysis.

Autor: Farsi S; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Benafield A; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Dorman J; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Gardner JR; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Hairston HC; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Rereddy RS; Stony Brook University Medical Center, General Surgery, Stony Brook, NY, USA., Nakanishi H; Department of surgery, Mayo Clinic, Rochester, MN, USA., King D; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Steelman SC; University of Arkansas for Medical Sciences Library, Little Rock, AR, USA., Vural E; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Moreno MA; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA., Sunde J; Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA. Electronic address: jumins8@gmail.com.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2024 Nov 14, pp. 104508. Date of Electronic Publication: 2024 Nov 14.
DOI: 10.1016/j.amjoto.2024.104508
Abstrakt: Objective: This study aims to evaluate the success rates and complications associated with different free flap donor sites used in surgical reconstruction for mandibular osteoradionecrosis, providing insights to aid clinical decision-making.
Data Sources: MEDLINE, Embase, Cochrane, and Web of Science.
Review Methods: Comprehensive database searches were conducted up to October 2023. Three independent reviewers screened articles per PRISMA guidelines. This review is registered with PROSPERO (CRD42023456929). Meta-analysis, using inverse variance statistical method and a random effects model, was performed with OpenMeta software (Version 10.12, Brown University, USA). Study quality was assessed via the methodological index for non-randomized studies (MINORS).
Results: Nineteen full-text articles met inclusion criteria, encompassing 397 patients and 424 free flap procedures. Patients averaged 54.8 years old; 27.5 % were female. Squamous cell carcinoma was the main radiation indication (83.1 %). Flap types included fibula (63 %), iliac crest (36 %), scapula (3.7 %), and radial forearm (3.5 %). Symptoms of osteoradionecrosis appeared on average four years post-radiation therapy, with a mean dose of 6346 cGy. Pooled postoperative complication rate was 22.5 % (95 % CI 0.165-0.284, I 2 :48%). Radial forearm flaps had the lowest complication rate (13.5 %, 95 % CI 0.026-0.295, I 2 :0%), while scapula flaps had the highest (34.9 %, 95 % CI 0.039-0.66, I 2 :40.3 %). Fibula flaps had the lowest failure rate (3.3 %, 95 % CI 0.003-0.025, I 2 :0%), while iliac crest flaps had the highest (11.9 %, 95 % CI 0.022-0.260, I 2 :60.4 %).
Conclusion: The fibula is the preferred flap for mandibular reconstruction due to its low failure rate. Radial forearm flaps show the fewest complications. More robust, multi-institutional prospective studies are needed.
Competing Interests: Declaration of competing interest All the authors declare no competing interests.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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