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Chimeric versus Multiple Flaps for Composite Oral Cavity Defects: A Systematic Review and Meta-Analysis
Ayesha Punjabi1, Sthefano Araya1, Grace Amadio2
1Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A.
The Laryngoscope
|May 1, 2024
Summary
Chimeric flaps and multiple flaps offer similar survival rates for oral cavity reconstruction. While both methods are safe, multiple flaps may lead to longer hospital stays and more operating room returns for anastomotic issues.
Area of Science:
- Reconstructive Surgery
- Head and Neck Surgery
- Oral Oncology
Background:
- Complex head and neck defects often require reconstruction using either chimeric flaps or multiple flaps with separate anastomoses.
- Limited direct comparisons exist regarding the efficacy and outcomes of these two reconstructive strategies.
Purpose of the Study:
- To compare the outcomes of chimeric flaps versus multiple flaps in the reconstruction of oral cavity defects.
- To evaluate flap survival, complications, and functional recovery between the two reconstructive approaches.
Main Methods:
- A systematic review and meta-analysis of English-language articles was performed.
- Databases searched included PubMed, Embase, Web of Science, and Cochrane CENTRAL.
- Data extracted included patient demographics, flap type, flap survival, partial flap loss, operating room time, hospital stay, and postoperative complications.
Main Results:
- The meta-analysis included 47 articles with 1435 patients (883 chimeric flaps, 552 multiple flaps).
- Flap survival rates were comparable (98% for chimeric vs. 99% for multiple flaps; p=0.198).
- Multiple flap reconstructions showed higher rates of operating room take-backs for anastomotic issues and longer hospital stays, with no significant differences in other complications or functional outcomes.
Conclusions:
- Chimeric and multiple flaps demonstrate equivalent flap survival for composite oral cavity defect reconstruction.
- Both techniques are safe and acceptable, yielding similar results in functional recovery and complication rates.
- Multiple flaps are associated with increased operating room returns and prolonged hospitalizations compared to chimeric flaps.
