Comparison Of Mordibity After Reconstruction Of Oral And Maxillofacial Soft Tissue Defects After Oral Cancer Or Oropharyngeal Cancer With Anterolateral Thigh Flap And Forearm Flap:a Meta-analysis

Objective: To systematically review the mordibity after reconstruction of oral and maxillofacial soft tissue defects after oral cancer or oropharyngeal cancer with anterolateral thigh flap(ALTF)compared with forearm flap(FF),and to provide a theoretical evidence for the correct clinical selection on surgical procedure for maxillofacial soft tissue defects after removing of oral cancer or oropharyngeal cancer.Methods: We searched in databases including Wanfang Data,CNKI,Web of science,PubMed,Embase database to collect all the application of anterolateral thigh flap and forearm flap for the reconstruction of maxillofacial soft tissue defects after oral cancer or oropharyngeal cancer from inception to October 2017.The clinical controlled study or cohort study with flap survival rate,postoperative complications,and functional recovery of patients was evaluated according to the method of Cochrane systematic review.The valid data were extracted using RevMan 5.3 software which is provided by the Cochrane Collaboration for meta-analysis.Results: 33 clinical papers were included for meta-analysis.Total 1891 patients were included in 33 papers,in which,853 anterolateral thigh flaps and 1038 forearm flaps were performed.Comparing the ALTF group and the FF group,the results showed that flap failure rate was 3.75%(32/853)in the ALTF group and 3.37%(35/1038)in the FF group,P = 0.81;the rate of unclear speech was 6.64%(17/256)in the ALTF group and 7.36%(17/231)in the FF group,P=0.55;the incidence of poor facial shape was 4.88%(14/287)in the ALTF group and 3.88%(9/232)in the FF group,P=0.58;the incidence of abnormal diet was 27.74%(81/292)in the ALTF group and 36.40%(95/261)in the FF group,P=0.34;the incidence of complication was 15.47%(58/375)in the ALTF group and 15.02% in the FF group was 15.02%(67/446),P=0.60.There are no statistical difference between the two flaps in the above five indicators.The incidence of complication in the donor site was 3.10%(13/419)in the ALTF group and 15.97%(80/501)in the FF group,P=0.02,there was a statistical difference between the two groups.The incidence of the ALTF group was lower than that of the FF group.Conclusion: There is limited evidence that the anterolateral thigh flap is superior to the forearm flap in terms of the incidence of complication of the donor site,but the two repair methods are similar in terms of flap survival,functional recovery and recipient site complications.