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

Mohamed E Awad; Amara Altman; Radwa Elrefai; Peter Shipman; Stephen Looney; Mohammed Elsalanty

doi:10.1016/j.jcms.2019.01.037

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

J Craniomaxillofac Surg. 2019 Apr;47(4):629-641. doi: 10.1016/j.jcms.2019.01.037. Epub 2019 Feb 1.

Authors

Mohamed E Awad¹, Amara Altman², Radwa Elrefai³, Peter Shipman⁴, Stephen Looney⁵, Mohammed Elsalanty⁶

Affiliations

¹ Oral Biology Department, Dental College of Georgia, Augusta University, Augusta, GA, USA.
² Dental College of Georgia, Augusta University, Augusta, GA, USA.
³ Private Practice, Southfield, MI, USA.
⁴ Robert B. Greenblatt M.D. Library, Augusta University, Augusta, GA, USA.
⁵ Department of Biostatistics, Augusta University, Augusta, GA, USA.
⁶ Oral Biology Department, Dental College of Georgia, Augusta University, Augusta, GA, USA. Electronic address: melsalanty@augusta.edu.

PMID: 30782453
DOI: 10.1016/j.jcms.2019.01.037

Abstract

Background: 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.

Type of studies reviewed: 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.

Results: 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 < 0.0001, CI 0.3693 to 0.6979). Meta-analysis indicated no significant association in flap success between primary and secondary reconstruction, or lateral and antero-lateral defects.

Conclusion: Based on the available studies, this review found no evidence of difference in success or complication rates between primary and secondary reconstruction or between lateral and anterolateral defects. High-quality clinical studies are required to analyze the outcome of these techniques, especially regarding the impact of chemotherapy, radiation therapy, implant-supported dental prostheses, and preoperative planning, on the outcome of reconstruction.

Keywords: Bone; Dental implants; Mandibular reconstruction; Segmental defect; Vascularized fibula flap.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Bone Transplantation
Fibula*
Free Tissue Flaps*
Humans
Mandibular Reconstruction*
Observational Studies as Topic
Plastic Surgery Procedures