Abstract：
BACKGROUND: Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction.
METHODS: A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger\'s test.
RESULTS: A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I2 = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%).
CONCLUSIONS: Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
METHODS: A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer-reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (<18 years). We performed a random-effects meta-analysis with the inverse-variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by I2, and publication bias was examined using Egger\'s test.
RESULTS: A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7 years, were included in our study. Most free flaps originated from the fibula (n = 392/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (n = 179/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93-97, I2 = 0%), and recipient-site infections were estimated to occur in 9% (95% CI: 6-13, I2 = 0%) of cases. The most common reported complications within the study timeframe were early malocclusion (n = 28/123, 21.4%) and bite abnormalities (18/131, 13.7%).
CONCLUSIONS: Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.
摘要：
背景：血管化游离组织移植已被确立为下颌骨缺损重建的有效方法。然而,由于其很少出现,对其在儿科患者中的疗效了解有限.本研究的目的是系统地巩固小儿下颌骨重建中游离皮瓣的存活率和感染率。
方法：在OvidMedline上进行了系统的文献检索，Embase,和Cochrane图书馆在2024年1月之前发表的研究。我们纳入了同行评审的研究，报告了儿科患者（<18岁）与游离皮瓣下颌骨重建相关的生存和感染结果。我们使用逆方差加权方法进行了随机效应荟萃分析，以估计生存率和感染率。通过I2评估异质性，并使用Egger检验检查发表偏倚。
结果：共26项研究，报告了463例游离皮瓣和439例儿科患者，平均年龄为10.7岁，包括在我们的研究中。大多数游离皮瓣起源于腓骨（n=392/463，84.7％），良性肿瘤是下颌骨重建的最常见原因（n=179/463，38.7％）。皮瓣存活率的汇总估计为96%(95%CI:93-97,I2=0%),和受者部位感染估计发生在9%(95%CI:6-13,I2=0%)的病例中。研究时间范围内最常见的并发症是早期错牙合（n=28/123，21.4%）和咬合异常（18/131，13.7%）。
结论：游离组织移植用于小儿下颌骨重建是有效且安全的。需要进一步的研究来探索不同儿科人群下颌骨重建后的功能。
方法：在OvidMedline上进行了系统的文献检索，Embase,和Cochrane图书馆在2024年1月之前发表的研究。我们纳入了同行评审的研究，报告了儿科患者（<18岁）与游离皮瓣下颌骨重建相关的生存和感染结果。我们使用逆方差加权方法进行了随机效应荟萃分析，以估计生存率和感染率。通过I2评估异质性，并使用Egger检验检查发表偏倚。
结果：共26项研究，报告了463例游离皮瓣和439例儿科患者，平均年龄为10.7岁，包括在我们的研究中。大多数游离皮瓣起源于腓骨（n=392/463，84.7％），良性肿瘤是下颌骨重建的最常见原因（n=179/463，38.7％）。皮瓣存活率的汇总估计为96%(95%CI:93-97,I2=0%),和受者部位感染估计发生在9%(95%CI:6-13,I2=0%)的病例中。研究时间范围内最常见的并发症是早期错牙合（n=28/123，21.4%）和咬合异常（18/131，13.7%）。
结论：游离组织移植用于小儿下颌骨重建是有效且安全的。需要进一步的研究来探索不同儿科人群下颌骨重建后的功能。
