The Use of the Split Jejunal and Colon Patch Within the Oral Cavity: A Systematic Review and Meta-Analysis

For head and neck surgery, free jejunal and colon flaps are used primarily for reconstruction of pharyngo-laryngo or oesophageal defects in circumferential form. The use of these flaps in a split form is less well documented, especially for use in the mouth. The authors performed a systematic review to investigate the uses and complications of both these free flaps for use in the oral cavity. To do this, a systematic search was done utilising PRISMA guidelines in the databases of Medline, Cochrane, Embase, Web of Knowledge, and Google Scholar using Boolean operators. Articles were screened by 2 authors (T.M. and J.X.) using predefined inclusion and exclusion criteria. Quality of evidence was appraised by the same 2 authors using the Newcastle-Ottawa and AHRQ scales. Fourteen studies were included: 10 for free jejunal flaps, 3 for free colon flaps, and 1 paper covering both. Flap survival rates were similar to other types of free flaps for head and neck reconstruction at 96.29% (95% CI: 91.83%-100.00%) and 96.29% (95% CI: 88.76%-100.00%) for free jejunal flaps and free colon flaps, respectively. There was significant inconsistency between the reporting of both surgical and long-term functional outcomes, which made comparison difficult. A unique advantage of both free flaps involves their ability to secrete mucus. This provides an argument for consideration of the enteric free flaps to treat both local defects and concurrent pre-existing xerostomia, including in salvage surgery requiring reconstruction with a background of extensive radiotherapy or hyposalivation-related syndromes.