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Meta-Analysis
. 2022 Aug;167(2):224-235.
doi: 10.1177/01945998211044683. Epub 2021 Sep 7.

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis

Amit Walia  1 , Jake J Lee  1 , Ryan S Jackson  1 , Angela C Hardi  2 , Craig A Bollig  3 , Evan M Graboyes  4   5 , Joseph Zenga  6 , Sidharth V Puram  1   7 , Patrik Pipkorn  1
Affiliations
Meta-Analysis

Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis

Amit Walia et al. Otolaryngol Head Neck Surg. 2022 Aug.

Abstract

Objective: To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management.

Data sources: Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019.

Review methods: Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications.

Results: A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies, I2 = 12.8%). There was no difference in hospitalization length after secondary reconstruction between free tissue transfer and locoregional flaps or conservative management (relative risk of hospitalization ≥2 weeks, 96%; 95% CI, 0.80-1.14; n = 3 studies, I2 = 0). The pooled relative risk of perioperative complications following free tissue transfer was 0.60 when compared with locoregional flap or conservative management (95% CI, 0.40-0.92; n = 5 studies, I2 = 0).

Conclusion: Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.

Keywords: free flap failure; free flap salvage; free tissue transfer; free tissue transfer failure; head and neck reconstruction; head and neck reconstructive surgery; management of failed free flap; management of failed free tissue transfer; microvascular free flap.

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Conflict of interest statement

Competing Interests: None

Figures

FIGURE 1:
FIGURE 1:
Flow Diagram for Assessment of Eligible Studies in the Systematic Review and Meta-Analysis
FIGURE 2:
FIGURE 2:
Meta-analysis of studies evaluating survival rate of free flap following initial free flap failure for head and neck reconstruction.
FIGURE 3:
FIGURE 3:
Meta-analysis of studies evaluating pooled relative risk of hospitalization length ≥ 2 weeks for free tissue transfer compared to locoregional reconstruction / conservative management following initial free flap failure for head and neck reconstruction.
FIGURE 4:
FIGURE 4:
Meta-analysis of studies evaluating perioperative complications of free tissue transfer compared to locoregional reconstruction / conservative management following initial free flap failure for head and neck reconstruction.
FIGURE 5:
FIGURE 5:
Funnel plot analysis of survival rate of free tissue transfer after free flap failure for head and neck reconstruction.
See this image and copyright information in PMC

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