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Reconstruction of Head and Neck Defects Using a Dermal Regeneration Template: Systematic Review and Meta-Analysis
Martin R. Buta
1,
2, Cynthia T. Yusuf
3, Alexis K. Buckley
1,
2, Branko Bojovic
1,
2
1Division of Plastic & Reconstructive Surgery, Massachusetts General Hospital, Boston, MA 2Harvard Medical School, Boston, MA 3Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
Background: Acellular dermal matrices have been increasingly utilized as alternatives 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.
Methods: A systematic literature search was conducted to identify studies reporting use of a single type of dermal regeneration template for reconstructing head and neck defects after trauma or oncologic surgery. Patient demographics, indication for coverage, wound characteristics, complications, and post-operative course were analyzed and correlated with success of reconstruction. Success was defined as complete wound reepithelization after template application without the need for alternative methods of wound coverage.
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%) required flap coverage. Reconstruction of 64 defects (7.1%) resulted in minor complications. Overall, successful reconstructions were achieved for 796 defects (88%).
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 corroborate these results.
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