Abstract：
OBJECTIVE: The superficial temporal artery (STA) and facial artery (FA) are two commonly used recipient vessels when performing free tissue transfer to the head and neck. This meta-analysis compares the impact of recipient vessel location on free flap outcomes in scalp reconstruction.
METHODS: A systematic review was conducted following PRISMA-P guidelines using six databases. Studies reporting free tissue transfer using the STA or FA as a recipient vessel for reconstructing scalp defects were included. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool.
RESULTS: Of 3270 identified articles, 12 were included for final analysis. In total, 125 free flaps were identified (75 STA, 50 FA). Pooled analysis demonstrated an overall flap survival rate of 98.4% (STA 98.7% vs. FA 98.0%; p = .782). The mean defect size was significantly greater for flaps using the STA compared with the FA (223.7 ± 119.4 cm2 vs. 157.1 ± 96.5 cm2, p = .001). The FA group had a higher incidence of wound dehiscence than the STA group (14.0% vs. 1.3%, p = .005). However, meta-analysis demonstrated no significant difference in rates of wound dehiscence, flap loss, partial flap necrosis, venous congestion, or postoperative infection between groups.
CONCLUSIONS: This is the first systematic review and meta-analysis to assess recipient vessel selection in scalp reconstruction. Our results do not support a single vessel as the superior choice in scalp reconstruction. Rather, these findings suggest that the decision between using the STA or FA is multifaceted, requiring a flexible approach that considers the individual characteristics of each case. Further research is needed to explore additional factors influencing recipient vessel selection, including defect location, radiation therapy, and prior head and neck surgery.
METHODS: A systematic review was conducted following PRISMA-P guidelines using six databases. Studies reporting free tissue transfer using the STA or FA as a recipient vessel for reconstructing scalp defects were included. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool.
RESULTS: Of 3270 identified articles, 12 were included for final analysis. In total, 125 free flaps were identified (75 STA, 50 FA). Pooled analysis demonstrated an overall flap survival rate of 98.4% (STA 98.7% vs. FA 98.0%; p = .782). The mean defect size was significantly greater for flaps using the STA compared with the FA (223.7 ± 119.4 cm2 vs. 157.1 ± 96.5 cm2, p = .001). The FA group had a higher incidence of wound dehiscence than the STA group (14.0% vs. 1.3%, p = .005). However, meta-analysis demonstrated no significant difference in rates of wound dehiscence, flap loss, partial flap necrosis, venous congestion, or postoperative infection between groups.
CONCLUSIONS: This is the first systematic review and meta-analysis to assess recipient vessel selection in scalp reconstruction. Our results do not support a single vessel as the superior choice in scalp reconstruction. Rather, these findings suggest that the decision between using the STA or FA is multifaceted, requiring a flexible approach that considers the individual characteristics of each case. Further research is needed to explore additional factors influencing recipient vessel selection, including defect location, radiation therapy, and prior head and neck surgery.
摘要：
目的：进行游离组织转移到头颈部时，颞浅动脉（STA）和面动脉（FA）是两种常用的受体血管。这项荟萃分析比较了受体血管位置对头皮重建中游离皮瓣结果的影响。
方法：根据PRISMA-P指南使用六个数据库进行系统评价。包括报告使用STA或FA作为受体血管用于重建头皮缺损的游离组织转移的研究。感兴趣的结果包括皮瓣损失，皮瓣部分坏死,伤口裂开,静脉血栓形成,和感染率。使用ASPS标准和ROBINS-I工具进行质量评估。
结果：在3270篇确定的文章中，包括12个用于最终分析。总的来说,确定了125个自由皮瓣（75STA，50FA)。汇总分析显示皮瓣总体存活率为98.4%(STA98.7%vs.FA98.0%；p=.782）。与FA相比，使用STA的皮瓣的平均缺损尺寸明显更大（223.7±119.4cm2与157.1±96.5cm2，p=.001）。FA组的伤口裂开发生率高于STA组（14.0%vs.1.3%,p=.005）。然而,荟萃分析显示伤口裂开率无显著差异，皮瓣损失,皮瓣部分坏死,静脉充血,或术后组间感染。
结论：这是首次评估头皮重建中受体血管选择的系统评价和荟萃分析。我们的结果不支持单个血管作为头皮重建的首选。相反，这些结果表明，使用STA或FA之间的决定是多方面的，需要一种灵活的方法来考虑每个案例的个体特征。需要进一步的研究来探索影响受体血管选择的其他因素，包括缺陷位置，放射治疗,和之前的头颈部手术。
方法：根据PRISMA-P指南使用六个数据库进行系统评价。包括报告使用STA或FA作为受体血管用于重建头皮缺损的游离组织转移的研究。感兴趣的结果包括皮瓣损失，皮瓣部分坏死,伤口裂开,静脉血栓形成,和感染率。使用ASPS标准和ROBINS-I工具进行质量评估。
结果：在3270篇确定的文章中，包括12个用于最终分析。总的来说,确定了125个自由皮瓣（75STA，50FA)。汇总分析显示皮瓣总体存活率为98.4%(STA98.7%vs.FA98.0%；p=.782）。与FA相比，使用STA的皮瓣的平均缺损尺寸明显更大（223.7±119.4cm2与157.1±96.5cm2，p=.001）。FA组的伤口裂开发生率高于STA组（14.0%vs.1.3%,p=.005）。然而,荟萃分析显示伤口裂开率无显著差异，皮瓣损失,皮瓣部分坏死,静脉充血,或术后组间感染。
结论：这是首次评估头皮重建中受体血管选择的系统评价和荟萃分析。我们的结果不支持单个血管作为头皮重建的首选。相反，这些结果表明，使用STA或FA之间的决定是多方面的，需要一种灵活的方法来考虑每个案例的个体特征。需要进一步的研究来探索影响受体血管选择的其他因素，包括缺陷位置，放射治疗,和之前的头颈部手术。
