Background and objective: There exists limited outcome data regarding the survival of paediatric microvascular free flaps (MFFs) to the head and neck. The objectives of this study were to perform a systematic review of the literature, estimate the pooled survival rate of all MFFs, and perform a meta-analysis comparing survival of the most commonly used MFF for reconstructing head and neck defects in the paediatric population.

Methods: A systematic search of the literature was performed. Inclusion criteria included those studies using MFF to reconstruct head and neck defects in subjects less than, or equal to 18 years of age. A meta-analysis was used to compare the survival of the most commonly used MFF. The primary predictor variable was MFF type. The primary outcome variable was flap failure. Relative risk (RR) with 95% confidence intervals (CI) was assessed using a Mantel–Haenszel, fixed effects model. Heterogeneity was assessed using the I -squared statistic.

Results: We reviewed 16,529 abstracts. A total of 112 studies were reviewed in detail, forty-four meeting criteria for inclusion criteria. A total of 631 subjects received a total of 668 MFFs. The pooled survival rate was 96.9% among all MFFs. The free fibula and subscapular system flaps were the most common flaps utilized. There was no difference in survival of either the fibula (RR = 2.0, 95% CI: 0.6, 7.1, p = 0.3) or subscapular system flaps (RR = 0.7, 95% CI: 0.3, 2.2, p = 0.6), when separately compared to all other MFFs.

Conclusion: Free tissue transfer is highly successful in the paediatric population. Though data is limited, there appears to be no difference in the survival of various MFFs for head and neck reconstruction in the paediatric population.

Key words: free tissue flaps; paediatrics; craniofacial abnormalities; head and neck neoplasms

Acknowledgement: The authors have no financial interests to disclose.