Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2024 May;170(5):1280-1288. doi: 10.1002/ohn.689. Epub 2024 Feb 28.
To systematically review the literature to determine the prevalence of free flap failure in head and neck free flaps requiring vein grafting.
Search strategies created in collaboration with a medical librarian were implemented using PubMed, Cochrane, Scopus, Web of Science, and Google Scholar from inception to August 2022.
The population of interest included adult and pediatric patients undergoing reconstruction of oncologic or traumatic head and neck defects with a free flap requiring a vein graft that presents the success/failure rate. The primary outcome was the flap failure rate, and the secondary outcome was the flap compromise/revision rate. Inclusion and exclusion criteria were designed to capture all study designs. Initially, 2778 articles were identified by the search strategy. Two reviewers independently performed the review, data extraction for analysis, and a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Meta-analysis was performed using a random effects model.
Eleven studies of 789 flaps were included for data extraction. Random effects meta-analysis resulted in an estimated prevalence of free flap failure of 12.30% (95% confidence interval: 6.39%-19.49%, I = 77.4%).
Taking into account that head and neck free tissue transfers that require a vein graft are typically associated with more challenging reconstructions and the lack of a suitable alternative, vein grafts appear to be a reliable method for bridging the gap between the flap and recipient vessels in head and neck free tissue transfer when indicated.
系统回顾文献，以确定需要静脉移植的头颈部游离皮瓣失败的发生率。
与医学图书馆员合作创建的搜索策略在 2022 年 8 月之前使用 PubMed、Cochrane、Scopus、Web of Science 和 Google Scholar 进行了实施。
感兴趣的人群包括接受头颈部肿瘤或创伤性缺损重建的成年和儿科患者，使用游离皮瓣，需要静脉移植，呈现成功率/失败率。主要结果是皮瓣失败率，次要结果是皮瓣妥协/修订率。纳入和排除标准旨在捕获所有研究设计。最初，搜索策略确定了 2778 篇文章。两名审查员独立进行了审查、数据分析和质量评估。系统评价和荟萃分析的主要报告项目指南得到了遵循。使用随机效应模型进行荟萃分析。
11 项研究的 789 个皮瓣被纳入数据提取。随机效应荟萃分析得出游离皮瓣失败的估计发生率为 12.30%（95%置信区间：6.39%-19.49%，I=77.4%）。
考虑到头颈部游离组织转移需要静脉移植通常与更具挑战性的重建相关，并且缺乏合适的替代方法，当需要时，静脉移植似乎是在头颈部游离组织转移中连接皮瓣和受体血管的可靠方法。
