{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:07:21Z","timestamp":1780445241593,"version":"3.54.1"},"reference-count":45,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T00:00:00Z","timestamp":1717372800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Vascularized free tissue transfer has been established as an effective method in the reconstruction of mandibular defects. However, a limited understanding of its efficacy in pediatric patients persists due to its infrequent presentation. The aim of this study is to systematically consolidate the survival and infection rates of free flaps in pediatric mandibular reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic literature search was conducted on Ovid Medline, Embase, and Cochrane Library for studies published up to January 2024. We included peer\u2010reviewed studies reporting on survival and infection outcomes associated with free flap mandibular reconstruction in pediatric patients (&lt;18\u2009years). We performed a random\u2010effects meta\u2010analysis with the inverse\u2010variance weighted approach to estimate survival and infection rates. Heterogeneity was assessed by <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>, and publication bias was examined using Egger's test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 26 studies, reporting on 463 free flaps and 439 pediatric patients with a mean age of 10.7\u2009years, were included in our study. Most free flaps originated from the fibula (<jats:italic>n<\/jats:italic>\u2009=\u2009392\/463, 84.7%) and benign tumors were the most common cause for mandibular reconstruction (<jats:italic>n<\/jats:italic>\u2009=\u2009179\/463, 38.7%). The pooled estimate for survival of flaps was 96% (95% CI: 93\u201397, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%), and recipient\u2010site infections were estimated to occur in 9% (95% CI: 6\u201313, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%) of cases. The most common reported complications within the study timeframe were early malocclusion (<jats:italic>n<\/jats:italic>\u2009=\u200928\/123, 21.4%) and bite abnormalities (18\/131, 13.7%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Free tissue transfer for mandibular reconstruction in pediatric patients is effective and safe. Further research is required to explore functionality following mandibular reconstruction in diverse pediatric populations.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31200","type":"journal-article","created":{"date-parts":[[2024,6,3]],"date-time":"2024-06-03T08:45:31Z","timestamp":1717404331000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Survival and infection rates of microvascular free flaps in pediatric mandibular reconstruction: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3404-5376","authenticated-orcid":false,"given":"Ryan S.","family":"Huang","sequence":"first","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Benour","sequence":"additional","affiliation":[{"name":"Department of Medicine Royal College of Surgeons in Ireland  Dublin Leinster Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen W. Y.","family":"Wong Riff","sequence":"additional","affiliation":[{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery Hospital for Sick Children  Toronto Ontario 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