J Korean Assoc Oral Maxillofac Surg.  2025 Jan;51(1):3-16. 10.5125/jkaoms.2025.51.1.3.

Factors affecting anastomosis failure in microvascular fibula flap reconstruction of the maxillofacial region: a systematic review and meta-analysis

• Tahmasebi E
• Hajisadeghi S
• Shafiei S
• Moslemi H
• Tabrizi R
• Motamedi MHK

• KMID: 2565633
• DOI: http://doi.org/10.5125/jkaoms.2025.51.1.3

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.

Keyword

Surgical anastomosis; Fibula; Treatment outcome

Figure

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  Fig. 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram. Adapted from the article of Page et al.12 (BMJ 2021;372:n71) under the terms of the Creative Commons Attribution (CC BY 4.0) license.

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  Fig. 2 Forest plot of the pooled vascular failure rate for free fibula flap grafts. (CI: confidence interval, REML: residual maximum likelihood)

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  Fig. 3 Forest plot of the pooled vein thrombosis rate for free fibula flap grafts. (CI: confidence interval, REML: residual maximum likelihood)

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  Fig. 4 Forest plot of the pooled arterial thrombosis rate for free fibula flap grafts. (CI: confidence interval, REML: residual maximum likelihood)

Reference

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