Salzano Giovanni, Scocca Veronica, Troise Stefania, Abbate Vincenzo, Bonavolontà Paola, Vaira Luigi Angelo, Scarpa Alfonso, Lechien Jerome R, De Fazio Gianluca, Carraturo Emanuele, Dell'Aversana Orabona Giovanni
Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80131 Naples, Italy.
Maxillofacial Surgery Unit, Department of Clinical and Surgical Medicine, University Federico II, Via Pansini 5, 80131 Naples, Italy.
J Clin Med. 2025 May 8;14(10):3278. doi: 10.3390/jcm14103278.
This systematic review and meta-analysis evaluates the surgical, functional, and aesthetic outcomes of scapular free flaps in maxillary reconstruction. The primary objective is to assess early surgical complications, fistula formation, donor site morbidity, dental restoration, normal dietary intake, aesthetic compromise, and eye-related issues. Secondary objectives include total free flap necrosis, the need for revision procedures, and functional performance of the upper limb. A systematic review was conducted following the PRISMA guidelines. Eligible studies were identified by searching PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar, with the last search conducted on 10th February 2025. Inclusion criteria were studies reporting on patients undergoing maxillary reconstruction with scapular free flaps, and which provided data on at least one of the primary or secondary outcomes. A single-arm meta-analysis was performed to assess the outcomes of scapular free flap reconstruction. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale, with two independent reviewers performing the assessment. From an initial search of 310 articles, 6 studies were included in the qualitative and quantitative synthesis, encompassing 231 patients with a mean age of 52.9 years (95% CI 44.9-60.8). Early general surgical complications occurred in 24% (95% CI 13-40) of patients, while 12% (95% CI 4-31) experienced fistula formation. Donor site morbidity was reported in 10% (95% CI 6-17) of cases, with a mean DASH score of 10.49, indicating low upper limb impairment. Dental rehabilitation was achieved in 56% (95% CI 42-70), and 52% (95% CI 31-72) of patients resumed a normal diet. Aesthetic compromise was observed in 27% (95% CI 9-58), and 36% (95% CI 28-44) reported eye-related issues. Scapular free flap is a reliable option for maxillary reconstruction with favourable outcomes, particularly in complex composite defects requiring both bone and soft tissue reconstruction. However, the evidence is limited by risk of bias, significant heterogeneity, and imprecision due to the small number of studies and participants. Larger, more robust trials are needed to confirm these findings.
本系统评价和荟萃分析评估了肩胛游离皮瓣在上颌骨重建中的手术、功能和美学效果。主要目的是评估早期手术并发症、瘘管形成、供区并发症、牙齿修复、正常饮食摄入、美学缺陷和眼部相关问题。次要目的包括游离皮瓣完全坏死、翻修手术的必要性以及上肢的功能表现。按照PRISMA指南进行了系统评价。通过检索PubMed/MEDLINE、Cochrane图书馆、Scopus和谷歌学术搜索确定符合条件的研究，最后一次搜索于2025年2月10日进行。纳入标准为报告肩胛游离皮瓣上颌骨重建患者情况且提供至少一项主要或次要结局数据的研究。进行了单臂荟萃分析以评估肩胛游离皮瓣重建的效果。使用纽卡斯尔-渥太华质量评估量表评估偏倚风险，由两名独立 reviewers 进行评估。从最初检索的310篇文章中，6项研究纳入定性和定量综合分析，涵盖231例患者，平均年龄52.9岁（95%CI 44.9 - 60.8）。24%（95%CI 13 - 40）的患者发生早期一般外科并发症，12%（95%CI 4 - 31）出现瘘管形成。10%（95%CI 6 - 17）的病例报告有供区并发症，平均DASH评分为10.49，表明上肢功能损害较低。56%（95%CI 42 - 70）的患者实现牙齿修复，52%（95%CI 31 - 72）的患者恢复正常饮食。27%（95%CI 9 - 58）观察到美学缺陷，36%（95%CI 28 - 44）报告有眼部相关问题。肩胛游离皮瓣是上颌骨重建的可靠选择，效果良好，尤其适用于需要同时进行骨和软组织重建的复杂复合缺损。然而，由于研究和参与者数量较少，证据受到偏倚风险、显著异质性和不精确性的限制。需要更大规模、更有力的试验来证实这些发现。
