title: Microvascular Free Tissue Transfer for Head and Neck Reconstruction in Children: Part I.
abstract: BACKGROUND
  Limited outcome data exist regarding the survival of microvascular free flaps for head and neck reconstruction in children. The objectives of this study were to perform a systematic review of the literature and meta-analysis comparing the survival of the most commonly used free flaps used for head and neck reconstruction in children.
  
  
  METHODS
  A systematic search of PubMed, Embase, and Scopus was conducted using various keywords up to January 1, 2015. Meta-analysis was used to compare the survival of the most commonly used free flaps. The primary predictor variable was free flap type. The primary outcome variable was flap failure. The pooled relative risk (RR) with 95% confidence intervals (CIs) was estimated using a Mantel-Haenszel, fixed-effects model.
  
  
  RESULTS
  The authors reviewed 25,303 abstracts. Five studies met inclusion criteria. A total of 646 children received a total of 694 free flaps. The pooled survival rate among all free flaps was 96.4%. The fibula free flap (fibula) and subscapular system free flaps (scapula) were the most commonly used flaps. There was no difference in survival when comparing the scapula (RR = 0.59, 95% CI: 0.26, 1.56, P = 0.29), or fibula (RR = 1.91, 95% CI: 0.55, 6.65, P = 0.31) to other free flaps, or when comparing the scapula to the fibula (RR = 2.29; 95% CI: 0.40, 13.08, P = 0.35).
  
  
  CONCLUSIONS
  Free tissue transfer is highly successful in children. Although data are limited, there appears to be no difference in survival among various free flaps used for head and neck reconstruction in children.
authors.affiliation: *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.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Markiewicz
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Ruiz
authors.forename: Phillip
authors.initials: P
authors.lastname: Pirgousis
authors.forename: R
authors.initials: R
authors.lastname: Bryan Bell
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dierks
authors.forename: Sean P
authors.initials: SP
authors.lastname: Edwards
authors.forename: Rui
authors.initials: R
authors.lastname: Fernandes
mesh_terms: D002648:Child; D005360:Fibula / Q000637:transplantation; D058752:Free Tissue Flaps; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000637:transplantation