Incidence of flap-related complications in the oral reconstruction area after free flap reconstruction in patients with oral cancer

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BACKGROUND: This study aimed to ascertain the incidence of flap-related complications in the oral reconstruction area after free flap reconstruction (FFR) in patients with oral cancer (OC). METHODS: Pubmed, Embase, Cochrane Library, and Web of Science databases were searched for publicly available studies on flap-related complications in the oral reconstruction area after FFR in OC patients until August 2024. Data were extracted, and quality was appraised for eligible studies. The primary outcome indicator was the complication rate in the oral reconstruction area. Meta-analysis was performed using R 4.3.3 software. RESULTS: A total of 61 studies, involving 4831 patients and 4880 flaps, were included. Meta-analysis demonstrated that the overall incidence of complications in the oral reconstruction area after FFR in OC patients was 24% (95% CI: 0.20-0.28, p < 0.001). Subgroup analysis of complications indicated that the most common complications were wound dehiscence (10%), infections (9%), total/partial flap necrosis (7%), fistula (6%), vascular crises (5%), and bleeding/hematoma (4%) (all P < 0.05). CONCLUSION: The overall incidence of flap-related complications in the oral reconstruction area is high after FFR in OC patients, with wound dehiscence, infection, and flap necrosis occurring more commonly. Timely detection and proper management of these complications are crucial.