目的:比较腓骨游离皮瓣(FFF)术后并发症,肩胛骨游离皮瓣(SFF),头颈部骨重建后的前臂游离骨皮瓣(OCRFFF)。
方法:PUBMED,EMBASE,科克伦.
方法:使用系统评价的首选报告项目和Meta分析指南进行文献检索和系统评价。使用随机效应模型对比例进行荟萃分析,以比较手术时间和术后并发症。
结果:系统评价确定了26项研究,比较了至少1个感兴趣的变量。与FFF相比,优势比估计有利于降低OCRFFF的皮瓣故障率(0.7,置信区间[CI]:0.29-1.11,P<.001),而FFF和SFF相似。手术时间的平均差异估计显着有利于FFF,而不是SFF(-51.04分钟,CI:-92.73至-9.35,P=.016)和OCRFFF超过FFF(66.77分钟,CI:52.74-80.8,P<.001)。FFF更容易接触硬件,住院时间更长,和供体部位并发症。所有皮瓣类型的受体伤口并发症和瘘发生率相似。
结论:根据临床情况,OCRFFF,FFF,和SFF都是在头部和颈部重建强大的选择。OCRFFF与降低的襟翼故障率和更短的操作时间相关。SFF需要更长的操作时间,尽管机构之间存在显著差异。FFF具有广泛的重建指征,但与更多的围手术期和长期并发症相关。
OBJECTIVE: To compare the postoperative complications of the fibular free flap (FFF), scapula free flap (SFF), and osteocutaneous radial forearm free flap (OCRFFF) following osseous reconstruction in the head and neck.
METHODS: PUBMED, EMBASE, Cochrane.
METHODS: A literature search and systematic review were performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A meta-analysis of proportions was conducted using a random effects model to compare operative time and postoperative complications.
RESULTS: The systematic review identified 26 studies comparing at least 1 variable of interest. The odds ratio estimates favored reduced rates of flap failure with the OCRFFF when compared to FFF (0.7, confidence interval [CI]: 0.29-1.11, P < .001), while FFF and SFF were similar. The mean difference estimates for operative time significantly favored FFF over SFF (-51.04 minutes, CI: -92.73 to -9.35, P = .016) and OCRFFF over FFF (66.77 minutes, CI: 52.74-80.8, P < .001). The FFF was more prone to hardware exposure, longer hospital stays, and donor site complications. Recipient wound complications and fistula rates were similar for all flap types.
CONCLUSIONS: Depending on the clinical context, the OCRFFF, FFF, and SFF are all robust options for reconstruction in the head and neck. The OCRFFF is associated with a reduced rate of flap failure and shorter operative times. The SFF requires longer operative times, although significant variation was observed between institutions. The FFF has broad reconstructive indications but is associated with more perioperative and long-term complications.