The use of vascularized fibula flap in mandibular reconstruction; A comprehensive systematic review and meta-analysis of the observational studies

• Published in: Journal of cranio-maxillo-facial surgery 2019-04, Vol.47 (4), p.629-641
• Main Authors: Awad, Mohamed E., Altman, Amara, Elrefai, Radwa, Shipman, Peter, Looney, Stephen, Elsalanty, Mohammed
• Format: Article
• Language: English
• Subjects: Bone; Bone Transplantation; Dental implants; Fibula; Free Tissue Flaps; Humans; Mandibular Reconstruction; Observational Studies as Topic; Reconstructive Surgical Procedures; Segmental defect; Vascularized fibula flap
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2019.01.037

Vascularized fibular flaps are considered the gold standard for the reconstruction of segmental defects in the mandible. This review compares the complication and success rates of these techniques between primary and secondary reconstruction, as well as between lateral and antero-lateral defects. A systematic review and meta-analysis were conducted according to PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. The authors performed an independent comprehensive search using PubMed, Ovid MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and COS Conference Papers Index according to established inclusion and exclusion criteria. The methodological index for nonrandomized studies (MINORS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the type of reconstruction and location of the defect. Seventy-eight studies, involving 2461 patients, were eligible. 83.7% of the included patient received primary reconstruction with vascularized fibular flap. The overall flap success rate was 93%. There was improvement in MINORS quality score over time with positive correlation with the publication year (r = 0.5549, P