Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Washington University School of Medicine, St Louis, Missouri, USA.
Otolaryngol Head Neck Surg. 2023 May;168(5):970-978. doi: 10.1002/ohn.199. Epub 2023 Jan 25.
To systematically review the literature to determine the prevalence and risk of the free flap and postoperative complications in scalp-free tissue reconstruction with synthetic mesh cranioplasty.
Search strategies created with a medical librarian were implemented using multiple databases in May 2021.
Two reviewers independently performed the review, data extraction, and quality assessment. Cohort studies of patients with scalp-free tissue reconstruction with or without mesh cranioplasty were included. Studies that did not report whether mesh was used or did not separate outcomes by mesh use were excluded. The primary outcomes were free flap failure and postoperative complications. A random-effects model was used for the meta-analysis to estimate prevalence and prevalence ratios (PRs).
A total of 28 studies and 440 cases of scalp-free tissue reconstruction were included. The pooled prevalence of free flap failures and postoperative complications in patients with mesh cranioplasty was estimated at 7% (95% confidence interval [CI], 3%-17%; p = .85, I = 0%) and 21% (95% CI, 14%-31%; p = .44, I = 0%), respectively. In a subgroup analysis, mesh cranioplasty was not associated with a significantly increased risk of free flap failure or postoperative complications when compared to cases without mesh cranioplasty; pooled PR 1.21 (95% CI, 0.50-2.88; p = .90, I = 0%) for free flap failure and PR 1.85 (95% CI, 0.89-3.85; p = .28, I = 19) for postoperative complications.
Synthetic mesh cranioplasty does not significantly increase the risk of free flap compromise or postoperative complications. A higher prevalence of postoperative recipient site complications was observed in patients with mesh cranioplasty.
系统回顾文献，以确定游离皮瓣和术后并发症在使用合成网片颅骨修补的头皮游离组织重建中的发生率和风险。
2021 年 5 月，使用医学图书馆员创建的搜索策略，在多个数据库中实施了检索策略。
两位评审员独立进行了综述、数据提取和质量评估。纳入了接受或不接受网片颅骨修补的头皮游离组织重建的患者队列研究。未报告是否使用网片或未按网片使用情况对结果进行分类的研究被排除在外。主要结局是游离皮瓣失败和术后并发症。使用随机效应模型进行荟萃分析，以估计发生率和发生率比（PR）。
共纳入 28 项研究和 440 例头皮游离组织重建病例。使用网片颅骨修补的患者中，游离皮瓣失败和术后并发症的总发生率估计为 7%（95%置信区间[CI]，3%-17%；p=.85，I ²= 0%）和 21%（95% CI，14%-31%；p=.44，I ²= 0%）。在亚组分析中，与未使用网片颅骨修补的病例相比，网片颅骨修补与游离皮瓣失败或术后并发症的风险增加无关；游离皮瓣失败的合并 PR 为 1.21（95% CI，0.50-2.88；p=.90，I ²= 0%），术后并发症的合并 PR 为 1.85（95% CI，0.89-3.85；p=.28，I ²= 19%）。
合成网片颅骨修补不会显著增加游离皮瓣受损或术后并发症的风险。使用网片颅骨修补的患者术后受区并发症发生率较高。
