Comparison of the complications of mandibular reconstruction using fibula versus iliac crest flaps: an updated systematic review and meta-analysis

Abstract

The aim of this study was to review and compare the complications of mandibular reconstruction using the fibula or iliac crest flap. PubMed, Embase, and the Cochrane Library were systematically searched for available papers published up to May 2020. The primary outcomes were the number of failures, the number of patients with major donor site complications, and the number of patients with recipient site complications. Eighteen studies involving 942 patients were included (one randomized controlled trial, 12 cohort studies, and five case series). There was no difference between the fibula flap and the iliac crest flap regarding the odds ratio of failure (P = 0.563), donor site complications (P = 0.756), or recipient site complications (P = 0.452). There was no difference in the dental outcomes between the two flaps (P = 0.296). The sensitivity analyses suggest that the meta-analyses were robust. There was no publication bias. This meta-analysis suggests no difference between the fibula flap and the iliac crest flap regarding the odds ratios of failure, donor site complications, recipient site complications, and dental outcomes. The recent development of computer-aided design, 3D printing, and other technologies could optimize the surgical design, improve the success rate of the surgery, and reduce complications. Nevertheless, all non-randomized studies will be at a relatively high risk of bias. Therefore, caution should be exercised when interpreting the results of the analyses.

Keywords: fibula; iliac crest; mandibular reconstruction; meta-analysis; surgical flaps.