Free Flap Outcomes in Previously Irradiated Patients: A Meta‐analysis

Abstract

Objectives: (1) Understand the types of complications affecting head and neck free flap reconstructions. (2) Compare the incidence of flap complications between patients with and without prior irradiation. Methods: Systematic review and meta-analysis of all studies of head and neck free flap reconstructions between January 1993 and October 2013. Studies that included separate data for patients with and without prior irradiation were analyzed for differences in demographics, flap type, and complications using Poisson regression and odds ratios. Results: Fourteen studies encompassing 701 free flaps in irradiated patients and 328 free flaps in nonirradiated patients were included. The 2 groups were comparable in age ( P = .45), sex ( P = .45), and types of reconstructions. Postoperative complications such as complete flap failure (incidence rate ratio [95% confidence interval] 1.10 [0.59-2.05]; P = .74), fistula (1.93 [0.23-16.19]; P = .24), dehiscence (1.45 [0.70-2.97]; P = .15), infection (1.43 [0.37-5.34]; P = .46), vascular thrombosis (2.24 [0.20-24.46]; P = .27), hematoma (1.98 [0.312-12.57]; P = .27), partial flap loss (2.38 [0.334-17.02]; P = .18), and other complications including vascular compromise and hardware/bone exposure (1.33 [0.63-2.78]; P = .41) were not statistically different between the 2 groups. However, previously irradiated patients demonstrated a higher overall complication rate (46.3% vs 30.5%; 1.57 [1.02-2.41]; P = .001) when all complications were considered together. Conclusions: Head and neck free flap reconstruction in irradiated patients carries an increased risk of complications. The largest effect sizes were seen in risk of fistula, vascular thrombosis, hematoma, and partial flap loss, although these did not individually reach statistical significance. However, overall flap survival was similar in patients with and without radiation.