Non-Cochrane · intervention · PM41668631
Bony Union in Maxilla and Mandible Free Flap Reconstruction: A Systematic Review and Meta-Analysis.
Tran Khanh Linh, Heer Zora, Dial Harkaran Singh, et al. · Head & neck · 2026 · PubMed · doi:10.1002/hed.70153
Findings
Population Adults (18 years or older) undergoing maxilla or mandible reconstruction with a vascularized osseous free flap
10 findings
| Vascularized osseous free flap reconstruction of the maxilla or mandible | None (single-arm proportion) | Complete bony union rate Overall (all sites) | Proportion 0.87 [0.82, 0.91] GRADE not reported 52 studies · 3441 participants |
| Vascularized osseous free flap reconstruction of the maxilla or mandible | None (single-arm proportion) | Complete bony union rate Surgical site: mandible | Proportion 0.87 [0.82, 0.91] GRADE not reported 50 studies · 3415 participants |
| Vascularized osseous free flap reconstruction of the maxilla or mandible | None (single-arm proportion) | Complete bony union rate Surgical site: maxilla | Proportion 0.91 [0.48, 0.99] GRADE not reported 2 studies · 26 participants |
| Vascularized osseous free flap reconstruction of the mandible by flap type | None (single-arm proportion) | Complete bony union rate Flap type: fibula | Proportion 0.87 [0.79, 0.92] GRADE not reported Studies not reported |
| Vascularized osseous free flap reconstruction of the mandible by flap type | None (single-arm proportion) | Complete bony union rate Flap type: scapula | Proportion 0.87 [0.66, 0.96] GRADE not reported Studies not reported |
| Vascularized osseous free flap reconstruction of the mandible by flap type | None (single-arm proportion) | Complete bony union rate Flap type: radial forearm | Proportion 0.90 [0.78, 0.96] GRADE not reported Studies not reported |
| Vascularized osseous free flap reconstruction of the maxilla with the fibula flap | None (single-arm proportion) | Complete bony union rate Flap type: fibula (maxilla) | Proportion 0.91 [0.70, 0.98] GRADE not reported 2 studies · 26 participants |
| Vascularized osseous free flap reconstruction of the mandible with virtual surgical planning (VSP) | None (single-arm proportion) | Complete bony union rate Surgical technique: virtual surgical planning | Proportion 0.87 [0.74, 0.94] GRADE not reported 13 studies · 835 participants |
| Vascularized osseous free flap reconstruction of the mandible with freehand (unguided) surgery | None (single-arm proportion) | Complete bony union rate Surgical technique: freehand surgery | Proportion 0.87 [0.81, 0.92] GRADE not reported 37 studies · 2580 participants |
| Vascularized osseous free flap reconstruction of the mandible with virtual surgical planning | Freehand (unguided) surgery | Complete bony union rate Studies reporting both VSP and freehand surgery (mandible) | OR 0.90 [0.34, 2.37] GRADE not reported 6 studies · 698 participants |
Included primary studies 104
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Akashi 2015 Sequential evaluation for bone union of transferred fibula flaps in reconstructed mandibles: panoramic X-ray versus computed tomography DOI:10.1016/j.ijom.2015.04.014 | 2015 | this review only | not stated | not extracted yet |
| Akashi 2015 Sequential evaluation for bone union of transferred fibula flaps in reconstructed mandibles: panoramic X-ray versus computed tomography. PMID:26026771 | 2015 | this review only | not stated | not extracted yet |
| Al Afif 2024 Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis DOI:10.1002/micr.31243 | 2024 | this review only | not stated | not extracted yet |
| Al Afif 2024 Comparing the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis. PMID:39415549 | 2024 | this review only | not stated | not extracted yet |
| Barber 2016 Bone‐impacted fibular free flap: Long‐term dental implant success and complications compared to traditional fibular free tissue transfer DOI:10.1002/hed.24315 | 2015 | this review only | not stated | not extracted yet |
| Barber 2016 Bone-impacted fibular free flap: Long-term dental implant success and complications compared to traditional fibular free tissue transfer. PMID:26681661 | 2016 | this review only | not stated | not extracted yet |
| Barnard 1991 Osteosynthetic titanium mini-plate fixation of composite radial forearm flaps in mandibular reconstruction DOI:10.1016/s1010-5182(05)80064-2 | 1991 | this review only | not stated | not extracted yet |
| Barnard 1991 Osteosynthetic titanium mini-plate fixation of composite radial forearm flaps in mandibular reconstruction. PMID:1939670 | 1991 | this review only | not stated | not extracted yet |
| Barton 2023 Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction DOI:10.1002/lary.30574 | 2023 | this review only | not stated | not extracted yet |
| Barton 2023 Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction. PMID:36651328 | 2023 | this review only | not stated | not extracted yet |
| Blumberg 2019 Mandibular reconstruction with the scapula tip free flap DOI:10.1002/hed.25702 | 2019 | this review only | not stated | not extracted yet |
| Blumberg 2019 Mandibular reconstruction with the scapula tip free flap. PMID:30869822 | 2019 | this review only | not stated | not extracted yet |
| Boyd 1993 Fixation of the Vascularized Bone Graft in Mandibular Reconstruction DOI:10.1097/00006534-199302000-00010 | 1993 | this review only | not stated | not extracted yet |
| Boyd 1993 Fixation of the vascularized bone graft in mandibular reconstruction. PMID:8430141 | 1993 | this review only | not stated | not extracted yet |
| Chaine 2009 Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases DOI:10.1016/j.tripleo.2009.05.043 | 2009 | this review only | not stated | not extracted yet |
| Chaine 2009 Postoperative complications of fibular free flaps in mandibular reconstruction: an analysis of 25 consecutive cases. PMID:19699114 | 2009 | this review only | not stated | not extracted yet |
| Chang 2016 Long-Term Operative Outcomes of Preoperative Computed Tomography–Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible… DOI:10.1097/01.prs.0000475796.61855.a7 | 2016 | this review only | not stated | not extracted yet |
| Chang 2016 Long-Term Operative Outcomes of Preoperative Computed Tomography-Guided Virtual Surgical Planning for Osteocutaneous Free Flap Mandible… PMID:26818299 | 2016 | this review only | not stated | not extracted yet |
| Cohen 2024 Miniplate Versus Reconstruction Bar Fixation for Oncologic Mandibular Reconstruction with Free Fibula Flaps DOI:10.1055/a-2070-8677 | 2023 | this review only | not stated | not extracted yet |
| Cohen 2024 Miniplate Versus Reconstruction Bar Fixation for Oncologic Mandibular Reconstruction with Free Fibula Flaps. PMID:37030287 | 2024 | this review only | not stated | not extracted yet |
| Davidson 1991 A Comparison of the Results Following Oromandibular Reconstruction Using a Radial Forearm Flap with Either Radial Bone or a Reconstruction… DOI:10.1097/00006534-199108000-00004 | 1991 | this review only | not stated | not extracted yet |
| Davidson 1991 A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction… PMID:1852811 | 1991 | this review only | not stated | not extracted yet |
| Day 2014 Hardware Removal after Osseous Free Flap Reconstruction DOI:10.1177/0194599813512103 | 2013 | this review only | not stated | not extracted yet |
| Day 2014 Hardware removal after osseous free flap reconstruction. PMID:24201061 | 2014 | this review only | not stated | not extracted yet |
| Dean 2012 Free Flap Reconstruction of Lateral Mandibular Defects DOI:10.1177/0194599811430897 | 2011 | this review only | not stated | not extracted yet |
| Dean 2012 Free flap reconstruction of lateral mandibular defects: indications and outcomes. PMID:22166963 | 2012 | this review only | not stated | not extracted yet |
| Dean 2020 Fibula free flap in maxillomandibular reconstruction. Factors related to osteosynthesis plates’ complications DOI:10.1016/j.jcms.2020.08.003 | 2020 | this review only | not stated | not extracted yet |
| Dean 2020 Fibula free flap in maxillomandibular reconstruction. Factors related to osteosynthesis plates' complications. PMID:32893092 | 2020 | this review only | not stated | not extracted yet |
| Dholam 2018 Factors Affecting Dental Rehabilitation Following Jaw Reconstruction With Free-Fibular Graft In Patients With Head and Neck Cancer DOI:10.1097/scs.0000000000004824 | 2018 | this review only | not stated | not extracted yet |
| Dholam 2018 Factors Affecting Dental Rehabilitation Following Jaw Reconstruction With Free-Fibular Graft In Patients With Head and Neck Cancer. PMID:30339601 | 2018 | this review only | not stated | not extracted yet |
| Dimovska 2024 Clinical Outcomes of Scapular versus Fibular Free Flaps in Head and Neck Reconstructions: A Retrospective Study of 120 Patients DOI:10.1097/prs.0000000000011818 | 2024 | this review only | not stated | not extracted yet |
| Dimovska 2024 Clinical Outcomes of Scapular versus Fibular Free Flaps in Head and Neck Reconstructions: A Retrospective Study of 120 Patients. PMID:39422254 | 2025 | this review only | not stated | not extracted yet |
| Farwell 2006 Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction DOI:10.1002/hed.20455 | 2006 | this review only | not stated | not extracted yet |
| Farwell 2006 Efficacy of small reconstruction plates in vascularized bone graft mandibular reconstruction. PMID:16755584 | 2006 | this review only | not stated | not extracted yet |
| Ferri 1997 Advantages and limitations of the fibula free flap in mandibular reconstruction DOI:10.1016/s0278-2391(97)90685-6 | 1997 | this review only | not stated | not extracted yet |
| Ferri 1997 Advantages and limitations of the fibula free flap in mandibular reconstruction. PMID:9146512 | 1997 | this review only | not stated | not extracted yet |
| Futran 1995 Rigid Fixation of Vascularized Bone Grafts in Mandibular Reconstruction DOI:10.1001/archotol.1995.01890010056010 | 1995 | this review only | not stated | not extracted yet |
| Futran 1995 Rigid fixation of vascularized bone grafts in mandibular reconstruction. PMID:7803025 | 1995 | this review only | not stated | not extracted yet |
| Jenkins 2021 Dosimetry-guided virtual surgical planning in the reconstruction of mandibular osteoradionecrosis DOI:10.1016/j.bjoms.2021.02.010 | 2021 | this review only | not stated | not extracted yet |
| Jenkins 2021 Dosimetry-guided virtual surgical planning in the reconstruction of mandibular osteoradionecrosis. PMID:34256959 | 2021 | this review only | not stated | not extracted yet |
| Karadaghy 2022 Rates of bone reabsorption and union in mandibular reconstruction using the osteocutaneous radial forearm free flap DOI:10.1002/hed.26939 | 2021 | this review only | not stated | not extracted yet |
| Karadaghy 2022 Rates of bone reabsorption and union in mandibular reconstruction using the osteocutaneous radial forearm free flap. PMID:34816528 | 2022 | this review only | not stated | not extracted yet |
| Kim 2007 Latissimus-Serratus-Rib Free Flap for Oromandibular and Maxillary Reconstruction DOI:10.1001/archotol.133.8.791 | 2007 | this review only | not stated | not extracted yet |
| Kim 2007 Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction. PMID:17709618 | 2007 | this review only | not stated | not extracted yet |
| Kim 2015 Comparison of miniplates and biodegradable plates in reconstruction of the mandible with a fibular free flap DOI:10.1016/j.bjoms.2014.11.010 | 2015 | this review only | not stated | not extracted yet |
| Kim 2015 Comparison of miniplates and biodegradable plates in reconstruction of the mandible with a fibular free flap. PMID:25616846 | 2015 | this review only | not stated | not extracted yet |
| Knitschke 2022 Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A… DOI:10.3390/curroncol29050274 | 2022 | this review only | not stated | not extracted yet |
| Knitschke 2022 Osseous Union after Mandible Reconstruction with Fibula Free Flap Using Manually Bent Plates vs. Patient-Specific Implants: A… PMID:35621664 | 2022 | this review only | not stated | not extracted yet |
| Kreutzer 2022 Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study DOI:10.3389/fsurg.2022.778371 | 2022 | this review only | not stated | not extracted yet |
| Kreutzer 2022 Patient-Specific 3D-Printed Miniplates for Free Flap Fixation at the Mandible: A Feasibility Study. PMID:35372463 | 2022 | this review only | not stated | not extracted yet |
| Kreutzer 2023 Patient-specific 3D-printed mini-versus reconstruction plates for free flap fixation at the mandible: Retrospective study of clinical… DOI:10.1016/j.jcms.2023.09.019 | 2023 | this review only | not stated | not extracted yet |
| Kreutzer 2023 Patient-specific 3D-printed mini-versus reconstruction plates for free flap fixation at the mandible: Retrospective study of clinical… PMID:37852889 | 2023 | this review only | not stated | not extracted yet |
| Lampert 2024 Comparative study of CAD/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction DOI:10.3389/fonc.2024.1438269 | 2024 | this review only | not stated | not extracted yet |
| Lampert 2024 Comparative study of CAD/CAM reconstruction and miniplates for patient-specific fixation in LCL-type mandibular reconstruction. PMID:39323993 | 2024 | this review only | not stated | not extracted yet |
| Le 2022 Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap DOI:10.1002/micr.30841 | 2021 | this review only | not stated | not extracted yet |
| Le 2022 Complications in oncologic mandible reconstruction: A comparative study between the osteocutaneous radial forearm and fibula free flap. PMID:34792210 | 2022 | this review only | not stated | not extracted yet |
| Lee 2024 Is hardware colonization associated with latent hardware complications and removal in maxillomandibular free flap reconstruction? DOI:10.1002/hed.27627 | 2024 | this review only | not stated | not extracted yet |
| Lee 2024 Is hardware colonization associated with latent hardware complications and removal in maxillomandibular free flap reconstruction? PMID:38193600 | 2024 | this review only | not stated | not extracted yet |
| Mericli 2017 Using a Second Free Fibula Osteocutaneous Flap after Repeated Mandibulectomy Is Associated with a Low Complication Rate and Acceptable… DOI:10.1097/prs.0000000000003523 | 2017 | this review only | not stated | not extracted yet |
| Mericli 2017 Using a Second Free Fibula Osteocutaneous Flap after Repeated Mandibulectomy Is Associated with a Low Complication Rate and Acceptable… PMID:28746288 | 2017 | this review only | not stated | not extracted yet |
| Navarro Cuellar 2021 Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard… DOI:10.1016/j.joms.2020.08.003 | 2021 | this review only | not stated | not extracted yet |
| Navarro Cuéllar 2021 Primary Maxillary Reconstruction With Fibula Flap and Dental Implants: A Comparative Study Between Virtual Surgical Planning and Standard… PMID:32890473 | 2021 | this review only | not stated | not extracted yet |
| O'Connell 2021 Outcomes of microvascular composite reconstruction for mandibular osteoradionecrosis DOI:10.1016/j.bjoms.2020.11.013 | 2021 | this review only | not stated | not extracted yet |
| O'Connell 2021 Outcomes of microvascular composite reconstruction for mandibular osteoradionecrosis. PMID:34531074 | 2021 | this review only | not stated | not extracted yet |
| Palla 2024 Factors Affecting Bone Fusion in Mandibular Reconstruction With Vascularized Free Fibula Flap DOI:10.1097/scs.0000000000010220 | 2024 | this review only | not stated | not extracted yet |
| Powell 2014 Resorption of fibula bone following mandibular reconstruction for osteoradionecrosis DOI:10.1016/j.bjoms.2014.02.005 | 2014 | this review only | not stated | not extracted yet |
| Powell 2014 Resorption of fibula bone following mandibular reconstruction for osteoradionecrosis. PMID:24613371 | 2014 | this review only | not stated | not extracted yet |
| Rashid 2012 Mandibular reconstruction using osteocutaneous radial forearm flap. PMID:22868019 | 2012 | this review only | not stated | not extracted yet |
| Rendenbach 2019 Complication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD/CAM versus conventional fixation in 128… DOI:10.1016/j.ijom.2019.01.029 | 2019 | this review only | not stated | not extracted yet |
| Rendenbach 2019 Complication rates and clinical outcomes of osseous free flaps: a retrospective comparison of CAD/CAM versus conventional fixation in 128… PMID:30792087 | 2019 | this review only | not stated | not extracted yet |
| Robey 2008 Comparison of Miniplates and Reconstruction Plates in Fibular Flap Reconstruction of the Mandible DOI:10.1097/prs.0b013e31818a9ac5 | 2008 | this review only | not stated | not extracted yet |
| Robey 2008 Comparison of miniplates and reconstruction plates in fibular flap reconstruction of the mandible. PMID:19050525 | 2008 | this review only | not stated | not extracted yet |
| Sabiq 2024 Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery DOI:10.1002/hed.27759 | 2024 | this review only | not stated | not extracted yet |
| Sabiq 2024 Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery. PMID:38545772 | 2024 | this review only | not stated | not extracted yet |
| Sawhney 2013 Management of Pathologic Fractures of the Mandible Secondary to Osteoradionecrosis DOI:10.1177/0194599812463186 | 2012 | this review only | not stated | not extracted yet |
| Sawhney 2013 Management of pathologic fractures of the mandible secondary to osteoradionecrosis. PMID:23034514 | 2013 | this review only | not stated | not extracted yet |
| Silverman 2016 Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An… DOI:10.1002/hed.23919 | 2015 | this review only | not stated | not extracted yet |
| Silverman 2016 Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An… PMID:25354911 | 2016 | this review only | not stated | not extracted yet |
| Smolka 2008 Fibula free flap reconstruction of the mandible in cancer patients: Evaluation of a combined surgical and prosthodontic treatment concept DOI:10.1016/j.oraloncology.2007.07.005 | 2008 | this review only | not stated | not extracted yet |
| Smolka 2008 Fibula free flap reconstruction of the mandible in cancer patients: evaluation of a combined surgical and prosthodontic treatment concept. PMID:17938001 | 2008 | this review only | not stated | not extracted yet |
| Speed 2024 Virtual surgical planning for mandibular reconstruction in an abbreviated admission pathway DOI:10.1016/j.amjoto.2023.104141 | 2024 | this review only | not stated | not extracted yet |
| Speed 2024 Virtual surgical planning for mandibular reconstruction in an abbreviated admission pathway. PMID:38194889 | 2024 | this review only | not stated | not extracted yet |
| Sullivan 1990 The free scapular flap for head and neck reconstruction DOI:10.1016/0196-0709(90)90062-z | 1990 | this review only | not stated | not extracted yet |
| Sullivan 1990 The free scapular flap for head and neck reconstruction. PMID:2264583 | 1990 | this review only | not stated | not extracted yet |
| Sun 2010 Reconstruction of High Maxillectomy Defects with the Fibula Osteomyocutaneous Flap in Combination with Titanium Mesh or a Zygomatic Implant DOI:10.1097/prs.0b013e3181fad2d3 | 2011 | this review only | not stated | not extracted yet |
| Sun 2011 Reconstruction of high maxillectomy defects with the fibula osteomyocutaneous flap in combination with titanium mesh or a zygomatic implant. PMID:21200209 | 2011 | this review only | not stated | not extracted yet |
| Sweeny 2012 Use of Recombinant Bone Morphogenetic Protein 2 in Free Flap Reconstruction for Osteonecrosis of the Mandible DOI:10.1016/j.joms.2011.08.037 | 2012 | this review only | not stated | not extracted yet |
| Sweeny 2012 Use of recombinant bone morphogenetic protein 2 in free flap reconstruction for osteonecrosis of the mandible. PMID:22177824 | 2012 | this review only | not stated | not extracted yet |
| Toto 2015 Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning DOI:10.1002/hed.23815 | 2015 | this review only | not stated | not extracted yet |
| Toto 2015 Improved operative efficiency of free fibula flap mandible reconstruction with patient-specific, computer-guided preoperative planning. PMID:24954814 | 2015 | this review only | not stated | not extracted yet |
| Trignano 2013 Free fibular flap with periosteal excess for mandibular reconstruction DOI:10.1002/micr.22159 | 2013 | this review only | not stated | not extracted yet |
| Trignano 2013 Free fibular flap with periosteal excess for mandibular reconstruction. PMID:23946213 | 2013 | this review only | not stated | not extracted yet |
| Vranckx 2023 Maxillomandibular Reconstruction Using Insourced Virtual Surgical Planning and Homemade CAD/CAM: A Single-Center Evolution in 75 Patients DOI:10.1097/prs.0000000000010142 | 2023 | this review only | not stated | not extracted yet |
| Vranckx 2023 Maxillomandibular Reconstruction Using Insourced Virtual Surgical Planning and Homemade CAD/CAM: A Single-Center Evolution in 75 Patients. PMID:36728691 | 2023 | this review only | not stated | not extracted yet |
| Walia 2021 A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction DOI:10.1002/lary.29430 | 2021 | this review only | not stated | not extracted yet |
| Walia 2021 A Comprehensive Analysis of Complications of Free Flaps for Oromandibular Reconstruction. PMID:33571385 | 2021 | this review only | not stated | not extracted yet |
| Yang 2024 Long‐Term Plate Complications in Patient‐Specific Plates Utilizing Computer‐Aided Design DOI:10.1002/lary.31640 | 2024 | this review only | not stated | not extracted yet |
| Yang 2024 Long-Term Plate Complications in Patient-Specific Plates Utilizing Computer-Aided Design. PMID:39016186 | 2024 | this review only | not stated | not extracted yet |
| Yeh 2019 Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap DOI:10.1002/hed.25342 | 2018 | this review only | not stated | not extracted yet |
| Yeh 2019 Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap. PMID:30511790 | 2019 | this review only | not stated | not extracted yet |
| Yla-Kotola 2013 Union and Bone Resorption of Free Fibular Flaps in Mandibular Reconstruction DOI:10.1055/s-0033-1343953 | 2013 | this review only | not stated | not extracted yet |
| Yla‐Kotola 2013 Union and bone resorption of free fibular flaps in mandibular reconstruction. PMID:23616254 | 2013 | this review only | not stated | not extracted yet |
| Zender 2012 Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction DOI:10.1002/lary.23326 | 2012 | this review only | not stated | not extracted yet |
| Zender 2012 Etiologic causes of late osteocutaneous free flap failures in oral cavity cancer reconstruction. PMID:22565542 | 2012 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients aged 18 years and older undergoing maxilla or mandible reconstruction with a vascularized osseous free flap | Adults with mandible or maxilla reconstruction with osseous free flap (sample sizes 6 to 240; 52 studies) |
| Intervention | Vascularized osseous free flap reconstruction (flap types, virtual surgical planning vs freehand) | Fibula, radial forearm, scapula and other osseous free flaps; virtual surgical planning and freehand surgery |
| Comparison | Not specified | Not specified |
| Outcomes | Postoperative bony union (rate of complete union, definition, imaging, time to assessment, nonunion treatment) | Complete bony union rate, definitions of union, nonunion treatment (11 studies) |
| Study designs | Case series with more than 5 patients, retrospective and prospective observational studies, clinical trials | 51 retrospective studies and 1 prospective study; no prospective controlled studies |
| Timing | Studies from 1990 to January 2025 | Follow-up 1.38 to 57 months |