title: Survival of microvascular free flaps in mandibular reconstruction: A systematic review and meta-analysis.
abstract: BACKGROUND
  Free tissue transfer is commonly used in the reconstruction of post-ablative defects of the mandible. Due to lack of statistical power, comparing the survival of various free flaps, even in large studies, is challenging. The purpose of this study was to perform a meta-analysis comparing the survival of the most commonly used free flaps for mandibular reconstruction.
  
  
  METHODS
  We searched PubMed, EMBASE, and SCOPUS for relevant studies. A meta-analysis using the Peto one-step odds ratio (OR) with 95% confidence intervals (CI) was used to compare the pooled survival of the most commonly used free flaps for mandibular reconstruction.
  
  
  RESULTS
  Of the 25,303 studies reviewed, 17 were selected for data extraction. A total of 1,221 subjects received 1,262 free flaps. Sixty-five free flaps failed. The pooled survival of all free flaps used for mandibular reconstruction was 94.8%. The deep circumflex iliac artery (DCIA) flap was associated with a seven-fold increase in failure when compared to the radial forearm free flap (Peto OR 7.40; 95% CI 1.38, 39.75, P = 0.02). There was no difference in survival when comparing other commonly used free flaps.
  
  
  CONCLUSIONS
  The results of this study suggest that free flap reconstruction of the mandible is highly successful. With the exception of the increased survival of the radial forearm when compared to the DCIA, there is no difference in recipient site survival when comparing various free flaps for mandibular reconstruction.
authors.affiliation: Division of Head Neck Surgery, Department of Oral & Maxillofacial Surgery, Division of Surgical Oncology, University of Florida College of Medicine, Jacksonville, FL.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Markiewicz
authors.affiliation: Oral, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR.|Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.|Head and Neck Institute, Portland, OR.
authors.forename: R Bryan
authors.initials: RB
authors.lastname: Bell
authors.affiliation: Oral, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR.|Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.|Head and Neck Institute, Portland, OR.
authors.forename: Tuan G
authors.initials: TG
authors.lastname: Bui
authors.affiliation: Oral, Head and Neck Cancer Program, Providence Cancer Center, Portland, OR.|Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.|Head and Neck Institute, Portland, OR.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dierks
authors.affiliation: Department of Pediatric Craniomaxillofacial Surgery, Arnold Palmer Hospital for Children University of Central Florida, Orlando, FL.
authors.forename: Ramon
authors.initials: R
authors.lastname: Ruiz
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Savannah
authors.initials: S
authors.lastname: Gelesko
authors.affiliation: Division of Head Neck Surgery, Department of Oral & Maxillofacial Surgery, Division of Surgical Oncology, University of Florida College of Medicine, Jacksonville, FL.
authors.forename: Phillip
authors.initials: P
authors.lastname: Pirgousis
authors.affiliation: Division of Head Neck Surgery, Department of Oral & Maxillofacial Surgery, Division of Surgical Oncology, University of Florida College of Medicine, Jacksonville, FL.
authors.forename: Rui
authors.initials: R
authors.lastname: Fernandes
mesh_terms: D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006801:Humans; D063175:Mandibular Reconstruction / Q000379:methods*; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care