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. 2021 Oct 22;16(10):e0257457.
doi: 10.1371/journal.pone.0257457. eCollection 2021.

Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis

Mubarak Ahmed Mashrah  1   2 , Taghrid Aldhohrah  3 , Ahmed Abdelrehem  4 , Karim Ahmed Sakran  5 , Hyat Ahmad  6 , Hamada Mahran  7 , Faisal Abu-Lohom  2 , Hanfu Su  1 , Ying Fang  1 , Liping Wang  1
Affiliations

Survival of vascularized osseous flaps in mandibular reconstruction: A network meta-analysis

Mubarak Ahmed Mashrah et al. PLoS One. .

Abstract

Objective: An evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction.

Methods: From inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated.

Results: Twenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34)).

Conclusion: Within the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate.

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Conflict of interest statement

The authors reported no conflicts of interest related to this study.

Figures

Fig 1
Fig 1. Study flow diagram.
Fig 2
Fig 2. Forest plot pairwise direct comparison of FFF versus DCIA.
Fig 3
Fig 3. Network map of all direct comparisons of reported by all included articles in the network meta-analysis.
The thickness of the line correlates with the number of comparisons made.
Fig 4
Fig 4. NMA forest plot, comparison of the included interventions: Odds ratio (95% CrI).
Fig 5
Fig 5. Rankogram of different osseous flap.
Rank 1 correlates with the lowest incidence of flap failure.
Fig 6
Fig 6. Comparison-adjusted funnel plots of different osseous free flaps.
See this image and copyright information in PMC

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