title: Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years.
abstract: To explore the techniques for mandibular reconstruction with composite free flaps and their outcomes, we systematically reviewed reports published between 1990 and 2015. A total of 9499 mandibular defects were reconstructed with 6178 fibular, 1380 iliac crest, 1127 composite radial, 709 scapular, 63 serratus anterior and rib, 32 metatarsal, and 10 lateral arm flaps including humerus. The failure rate was higher for the iliac crest (6.2%, 66/1059) than for fibular, radial, and scapular flaps combined (3.4%, 202/6018) (p<0.001). We evaluated rates of osteotomy, non-union, and fistulas. Implant-retained prostheses were used most often for rehabilitation after reconstruction with iliac crest (44%, 100/229 compared with 26%, 605/2295 if another flap was used) (p<0.001). There were no apparent changes in the choice of flap or in the complications reported. Although we were able to show some significant differences relating to the types of flap used, we were disappointed to find that fundamental outcomes such as the need for osteotomy, and rates of non-union and fistulas were under-reported. This review shows the need for more comprehensive and consistent reporting of outcomes to enable the comparison of different techniques for similar defects.
authors.affiliation: Aintree University Hospital and Warrington Hospital, Liverpool University, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, United Kingdom. Electronic address: brownjs@doctors.org.uk.
authors.forename: J S
authors.initials: JS
authors.lastname: Brown
authors.affiliation: Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk, L39 4QP. Electronic address: astraglobeltd@btconnect.com.
authors.forename: D
authors.initials: D
authors.lastname: Lowe
authors.affiliation: Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute, Faculty of Medicine and Health, Clarendon Way, Leeds LS2 9LU, United Kingdom. Electronic address: a.kanatas@doctors.org.uk.
authors.forename: A
authors.initials: A
authors.lastname: Kanatas
authors.affiliation: Liverpool University, Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, United Kingdom. Electronic address: schache@liverpool.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Schache
mesh_terms: D016025:Bone Transplantation; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D063175:Mandibular Reconstruction / Q000379:methods*; D013997:Time Factors
keywords: Mandible; free tissue transfer; head and neck; reconstruction; reconstructive microsurgery