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Head and Neck Surgery

A Meta-analysis of Osseous Reconstruction in the Head and Neck

Sunday, October 1, 2023
4:33 PM - 4:39 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Usman G. Khan, MD, MSc

    Resident Physician
    Division of Otolaryngology-Head and Neck Surgery Dalhousie University
    HALIFAX, NS, Canada

    • Co-Author(s)

  • KH

    Kalpesh Hathi, MD

    Resident Physician
    Division of Otolaryngology - Head and Neck Surgery, Dalhousie University
    Halifax, NS, Canada

  • CM

    Colin MacKay, MSc

    Division of Otolaryngology-Head and Neck Surgery Dalhousie University, USA

    • Senior Author(s)

  • Martin J. Corsten, MD

    Associate Professor
    Dalhousie University
    Halifax, NS, Canada

Introduction: The fibular free flap (FFF), scapula free flap (SFF) and osteocutaneous radial forearm free flap (OCRFF) are the primary options for osseous reconstruction in the head and neck. The purpose of this study is to compare the perioperative and long-term complications of the FFF, SFF and OCRFF.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive literature search was performed for articles published prior to November 20th, 2022. A meta-analysis of proportions was conducted using a random effects model to compare perioperative and long-term complications.

Results: The systematic review identified 23 studies comparing at least one variable of interest from a total of 2144 articles. Flap failure was reported in 14 studies (3690 patients). The odds ratio (OR) estimates favored reduced rates of flap failure with the OCRFF when compared to FFF (0.72, CI 0.34 to 1.11, p< 0.01), while FFF and SFF remained similar. The mean difference (MD) estimates for operative time significantly favored FFF over SFF (51.04 minutes, CI 92.73 to 9.35, p=0.016) and OCRFF over FFF (66.77 minutes, CI 52.74-80.8, p< 0.001). Although the FFF was more prone to hardware exposure (OR 1.16, CI 0.7-1.63, p< 0.001), recipient wound complications (infection, dehiscence) were similar for all flap types. The FFF has a higher likelihood of fistula formation (vs OCRFF, OR 0.73, CI 0.3-1.16, P< 0.001) and donor site complications (vs SFF, OR 1.63, CI 0.86 to 2.41, P< 0.001). The length of hospital stay was not clinically or statistically different (MD 2.01 days). Data heterogeneity ranged from minimal to high, particularly for mean operative times (I2=73.2).

Conclusions: Depending on the clinical context, the OCRFF, FFF and SFF are all robust options for reconstruction in the head and neck. The OCRFF is associated with a reduced rate of flap failure. The SFF requires longer operative times, although significant variation was observed between institutions. The FFF has broad reconstructive indications but is associated with more long-term complications.