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Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children: Part I
Michael R Markiewicz1, Ramon L Ruiz, Phillip Pirgousis
1*Department of Oral and Maxillofacial Surgery, Division of Head Neck Surgery, Division of Surgical Oncology, University of Florida College of Medicine, Jacksonville †Department of Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children, University of Central Florida, Orlando, FL ‡Head and Neck Institute §Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR ||Department of Oral and Maxillofacial Surgery, Section of Pediatric Oral and Maxillofacial Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Free flap reconstruction in children for head and neck cancer is highly successful, with an overall survival rate of 96.4%. This systematic review found no significant difference in survival between common free flap types used in pediatric patients.
Area of Science:
- Pediatric reconstructive surgery
- Head and neck oncology
- Microsurgery outcomes
Background:
- Limited data exist on microvascular free flap survival for pediatric head and neck reconstruction.
- This study addresses the need for comprehensive outcome data in this specific population.
Purpose of the Study:
- To systematically review and meta-analyze the survival rates of commonly used free flaps in pediatric head and neck reconstruction.
- To compare the survival outcomes of different free flap types in children.
Main Methods:
- Systematic literature search of PubMed, Embase, and Scopus databases up to January 1, 2015.
- Meta-analysis comparing free flap survival using a fixed-effects model to estimate pooled relative risk (RR) and 95% confidence intervals (CIs).
- Primary outcome was flap failure, with free flap type as the predictor variable.
Main Results:
- Analysis of 5 studies involving 646 children and 694 free flaps.
- Overall pooled free flap survival rate was 96.4%.
- No statistically significant difference in survival was found when comparing fibula or subscapular system free flaps to other types, or when comparing these two flap types against each other.
Conclusions:
- Free tissue transfer demonstrates high success rates in pediatric head and neck reconstruction.
- Current evidence suggests comparable survival outcomes among various free flap options for this patient group, despite limited data.
