A comparison of postoperative outcomes based on recipient vessels in scalp free flap reconstruction: A systematic review and meta-analysis

IF 1.5 3区医学 Q3 SURGERY Microsurgery Pub Date : 2024-07-12 DOI:10.1002/micr.31211

Asli Pekcan BS, Idean Roohani BS, Eloise Stanton BA, Deborah Choe BA, Micaela Tomaro BS, Ishani D. Premaratne MD, Langley G. Wallace BA, Joseph N. Carey MD, David A. Daar MD, MBA

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Abstract

Purpose

The superficial temporal artery (STA) and facial artery (FA) are two commonly used recipient vessels when performing free tissue transfer to the head and neck. This meta-analysis compares the impact of recipient vessel location on free flap outcomes in scalp reconstruction.

Methods

A systematic review was conducted following PRISMA-P guidelines using six databases. Studies reporting free tissue transfer using the STA or FA as a recipient vessel for reconstructing scalp defects were included. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool.

Results

Of 3270 identified articles, 12 were included for final analysis. In total, 125 free flaps were identified (75 STA, 50 FA). Pooled analysis demonstrated an overall flap survival rate of 98.4% (STA 98.7% vs. FA 98.0%; p = .782). The mean defect size was significantly greater for flaps using the STA compared with the FA (223.7 ± 119.4 cm² vs. 157.1 ± 96.5 cm², p = .001). The FA group had a higher incidence of wound dehiscence than the STA group (14.0% vs. 1.3%, p = .005). However, meta-analysis demonstrated no significant difference in rates of wound dehiscence, flap loss, partial flap necrosis, venous congestion, or postoperative infection between groups.

Conclusion

This is the first systematic review and meta-analysis to assess recipient vessel selection in scalp reconstruction. Our results do not support a single vessel as the superior choice in scalp reconstruction. Rather, these findings suggest that the decision between using the STA or FA is multifaceted, requiring a flexible approach that considers the individual characteristics of each case. Further research is needed to explore additional factors influencing recipient vessel selection, including defect location, radiation therapy, and prior head and neck surgery.

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根据头皮游离皮瓣重建中的受体血管比较术后效果：系统回顾和荟萃分析。

目的：颞浅动脉（STA）和面动脉（FA）是头颈部进行游离组织转移时常用的两种受体血管。这项荟萃分析比较了受体血管位置对头皮重建游离皮瓣结果的影响：方法：根据 PRISMA-P 指南，使用六个数据库进行了系统性综述。方法：根据 PRISMA-P 指南，使用 6 个数据库进行了系统性回顾，纳入了报告使用 STA 或 FA 作为受体血管进行游离组织转移以重建头皮缺损的研究。相关结果包括皮瓣脱落、部分皮瓣坏死、伤口裂开、静脉血栓和感染率。采用ASPS标准和ROBINS-I工具进行质量评估：结果：在3270篇鉴定文章中，有12篇被纳入最终分析。总共确定了 125 个游离皮瓣（75 个 STA，50 个 FA）。汇总分析显示，皮瓣总存活率为 98.4%（STA 98.7% vs. FA 98.0%；P = .782）。使用 STA 的皮瓣的平均缺损面积明显大于使用 FA 的皮瓣（223.7 ± 119.4 平方厘米 vs. 157.1 ± 96.5 平方厘米，p = .001）。FA 组的伤口开裂发生率高于 STA 组（14.0% 对 1.3%，P = .005）。然而，荟萃分析表明，不同组间的伤口开裂、皮瓣脱落、部分皮瓣坏死、静脉充血或术后感染率无明显差异：这是首次对头皮重建中受体血管选择进行评估的系统回顾和荟萃分析。我们的研究结果并不支持单一血管作为头皮重建的最佳选择。相反，这些研究结果表明，决定使用 STA 还是 FA 是多方面的，需要考虑每个病例的个体特征，采取灵活的方法。还需要进一步研究探讨影响受体血管选择的其他因素，包括缺损位置、放射治疗和之前的头颈部手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.