Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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Factors affecting anastomosis failure in microvascular fibula flap reconstruction of the maxillofacial region: a systematic review and meta-analysis

  • Elahe Tahmasebi (Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences) ;
  • Samira Hajisadeghi (Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences) ;
  • Shervin Shafiei (Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Hamidreza Moslemi (Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Reza Tabrizi (Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Mohammad Hosein Kalantar Motamedi (Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences)
  • Received : 2023.06.28
  • Accepted : 2023.11.20
  • Published : 2025.02.28
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Abstract

This systematic review and meta-analysis evaluates the contributory factors and failure rates in anastomosis during microvascular fibula flap reconstruction in maxillomandibular regions. A comprehensive search strategy was employed across databases including MEDLINE, Web of Science, EMBASE, Scopus, Cochraneʼs CENTRAL, as well as grey literature sources, and manual searches of noteworthy journals, covering studies from inception up to April 2023. The inclusion criteria targeted retrospective or prospective cohort and clinical studies that investigated functional and dental rehabilitation outcomes in human subjects undergoing maxillofacial reconstruction using microvascular fibula flaps. Exclusion criteria encompassed case-control studies, alternative reconstruction method research, and animal-based investigations. The studyʼs findings revealed a cumulative vascular failure rate of 6%. Subsequent analysis delineated the primary causes of this failure, attributing 3% to venous thrombosis, 1% to arterial thrombosis, and less than 1% to blood vessel compression due to hematoma. However, notable heterogeneity across the studies indicates substantial variability in vascular failure rates reported. These results of our review and meta-analysis underscore the intricate factors impacting anastomosis success, such as anastomosis technique, recipient vessel quality, the choice between couplers.

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References

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