Meta Analysis Of Vascularized Fibula Flap And Iliac Flap In The Reconstruction Of Mandibular Defects

Objective: Vascularized fibula flap(FF)and iliac flap(IF)are two commonly used methods to repair mandibular defects caused by tumor,trauma or infection surgery.However,there is little comparison between the effects of two flaps.In present study,Meta-analysis was used to evaluate the reconstruction effect of mandible with these two vascularized bone flaps,and to provide theoretical basis for clinical mandible defects caused by diseases.Methods: The Chinese retrieval terms of "mandible","fibula" and "ilium" were used in Wanfang and CNKI databases.And we also searched in Pub Med,Embase and web of science databases with English terms "ilium" and "fibula" and "mandibular reconstruction".The manufactures involving comparison of clinical effects of vascularized fibula flap and ilium flap in the reconstruction of mandible defects caused by tumor operation,infection,trauma and radiation osteonecrosis were harvested.The retrieval period is from the establishment of the database to June 2019.The literatures were screened and selected by authors independently,according to the set inclusion / exclusion criteria,Furthermore,we searched additional relevant studies by manual searches and reference backtracking to get as much literature as possible.Meta analysis was carried out according to Revman 5.3 software provided by Cochrane collaborative network.The outcome indexes included flap failure rate,postoperative speech recovery,diet recovery,facial shape(Aesthetic Face)recovery,donor complications and recipient complications.The clinical effect was evaluated by odd ratio(OR)and 95% confidence interval(95% CI).Results: A total of 14 literatures were selected,among them,7 were written in English and 7 in Chinese.1212 patients were involved in those literatures,in which,683 cases underwent vascularized fibular flap and 529 cases underwent vascularized iliac flap.Meta analysis results showed that the flap failure rate of FF and IF were 5.12%(35/683)and 6.99%(37/599),respectively,there was statistical difference between the two groups[95% CI(0.35,0.90),P = 0.02],the flap failure rate in FF group was lower than that in IF group;The incidence of abnormal speech of FF and IF were 15.7%(17/108)and 12.8%(14/109)[95%CI(0.62,3.06),P=0.43];the incidence of abnormal diet of FF and IF were 4.07%(44/108)and 5.32%(58/109)[95%CI(0.18,13.33),P=0.68];the incidence of poor facial appearance of FF and IF were 10.2%(11/108)and 4.59%(5/109)[95%CI(0.66,5.88),P=0.22];the incidence rate of recipient site of FF and IF were 13.8%(27/195)and 28.9%(37/128)[95%CI(0.32,1.78),P=0.26];the incidence rate of donor site of FF and IF were 13.1%(33/252)and 13.9%(23/165)[95%CI(0.43,3.86),P=0.65].There was no significant difference in repair selection among the five outcome indicators above.Conclusion:According to the results,the vascularized fibular flap is superior to the vascularized iliac flap in terms of flap failure rate,but there is no significant difference between the two repair methods in the aspects of face type recovery,voice recovery,diet recovery,donor and recipient complications.