超显微手术是一种不断发展的方法,用于重建头颈部(HN)和颅面(CF)缺损。本系统综述旨在评估在HN和CF软组织缺损重建中使用超显微手术进行动脉或联合动脉和静脉吻合。以及相关的成功,总并发症,和再操作率。在PubMed上进行了文献检索,dynamed,DARE,EMBASE,科克伦,和英国医学杂志(BMJ)电子数据库(PROSPEROID:CRD42023476825)。9项研究符合纳入标准,有35例患者接受了超显微手术的软组织重建手术。对20例患者(57.1%)进行了21个皮瓣,其余15例(42.9%)进行了超显微外科再植。需要重建的最常见病理是HN创伤(n=16,45.7%),其次是恶性肿瘤(n=15,42.9%)。超显微手术的总成功率为98%(95%CI90~100,p=1.00;I2=0%)。所有研究的累积并发症发生率为46%(95%CI13-80,p<0.01;I2=0%),合并再手术率为1%(95%CI0~8,p=0.23;I2=24%)。使用超显微手术进行HN和CF软组织重建的总体成功率为98%,这与用于HN重建的传统显微外科相当。并发症和再手术率与以前的文献相当。这项研究证实了超显微外科手术作为HN和CF缺陷的安全可靠的重建选择的可行性。
Supermicrosurgery is an evolving approach in the reconstruction of head and neck (HN) and craniofacial (CF) defects. This systematic review aims to evaluate the use of supermicrosurgery for arterial or combined arterial and venous anastomoses in the reconstruction of HN and CF soft tissue defects, and the associated success, total complication, and reoperation rates. A literature search was conducted on PubMed, Dynamed, DARE, EMBASE, Cochrane, and British Medical Journal (BMJ) electronic databases (PROSPERO ID: CRD42023476825). Nine studies fulfilled the inclusion criteria with 35 patients who underwent soft tissue reconstructive procedures using supermicrosurgery. Twenty-one flaps were performed on 20 patients (57.1%) with the remaining 15 patients (42.9%) undergoing supermicrosurgical replantation. The most common pathology requiring reconstruction was HN trauma (n = 16, 45.7%) followed by malignancy (n = 15, 42.9%). The pooled success rate for supermicrosurgery was 98% (95% CI 90 to 100, p = 1.00; I2 = 0%). The cumulative complication rate across all the studies was 46% (95% CI 13 to 80, p < 0.01; I2 = 0%), and the pooled rate of reoperation was 1% (95% CI 0 to 8, p = 0.23; I2 = 24%). The use of supermicrosurgery for HN and CF soft tissue reconstruction has an overall success rate of 98%, which is commensurate with traditional microsurgery for HN reconstruction. Complication and reoperation rates are comparable to previous literature. This study confirms the feasibility of supermicrosurgery as a safe and reliable reconstructive option for HN and CF defects.