Reconstruction of Head and Neck Defects Using a Dermal Regeneration Template: Systematic Review and Meta-Analysis
*Cynthia Yusuf2, *Martin Buta1, *Alexis Buckley1, *Branko Bojovic1
1. Div. of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, United States. 2. University of Maryland School of Medicine, Baltimore, MD, United States.
OBJECTIVE: Acellular dermal matrices have been increasingly utilized as an alternative to flaps for soft tissue coverage in aesthetic and reconstructive surgery. This systematic review assesses clinical outcomes in cases using a dermal regeneration template for full-thickness head and neck defects resulting from trauma or oncologic surgery.
DESIGN: Systematic review and meta-analysis.
SETTING: Referral centers performing head and neck reconstruction.
PATIENTS: Adult patients who underwent reconstructive surgery using dermal regeneration template for full-thickness head and neck defects resulting from trauma or oncologic surgery.
INTERVENTIONS: Reconstructive surgery using dermal regeneration template for full-thickness head and neck defects resulting from trauma or oncologic surgery.
MAIN OUTCOME MEASURES: Patient demographics, indication for coverage, wound characteristics, number and type of complications, and post-operative course were analyzed and correlated with success of reconstruction. Success was defined as complete wound reepithelization from wound matrix application without the need for alternative methods of wound coverage. The primary outcomes of interest were major complications (return to the operating room, reapplication of wound matrix, or coverage with a flap) and minor complications (small hematoma/seroma, graft infection, wound dehiscence, or necrosis).
RESULTS: Of 904 articles screened, 21 met inclusion criteria. The aggregated data included 900 patients (mean age: 51.6 years, SD: 12.2; 608 males) and 904 defects (mean size: 51.1 cm2, SD: 45.9). The most common indication was oncologic reconstruction (n= 669) followed by burn trauma (n = 192). The most common operative site was the scalp (n= 252) followed by nose (n=110) and forehead (n=105). Analysis of pooled post-operative outcomes revealed 36 defects (4.0%) involved major complications, of which 12 (1.3%) necessitated flap coverage. Reconstruction of 64 defects (7.1%) resulted in minor complications: 48 defects (5.3%) involved graft infection, 11 defects (1.2%) hematoma/seroma, and 5 defects (0.6%) wound dehiscence/necrosis. Overall, successful reconstructions were achieved for 796 defects (88%). The mean follow-up period was 10.4 months (SD 8.7). Patients with a burn etiology were less likely to suffer from reconstructive failure (p < 0.044) while patients who underwent preoperative radiotherapy were more likely to suffer from reconstructive failure (p<0.032). Of articles reporting complication rates, pooled data demonstrated postoperative wound infection was significantly more likely to require flap coverage (p<0.026).
CONCLUSION: Reconstruction of head and neck defects using a dermal regeneration template is a safe and reliable technique associated with low complication rates. Higher quality comparative studies, including randomized controlled trials, are needed to further corroborate these results.
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