(634) Mapping Morbidity: Comparative Meta-Analyses of Donor-Site Complications in Free-Flap Reconstruction for Head & Neck Cancer

Introduction: Donor-site morbidity remains a critical determinant of long-term outcomes and patient quality of life following free-flap reconstruction of the head and neck; a multitude of free-flap donor sites are used in these reconstructions, though comparative data on specific donor-site morbidity remains fragmented in the literature. These meta-analyses synthesize available evidence to compare donor-site complication rates across commonly used flap types in head and neck reconstruction.

Methods: A systematic review and 6 single-proportion meta-analyses were conducted in October of 2025, employing PRISMA guidelines. A search of the PubMed database yielded 3312 results. After duplicate article removal and title and abstract screening, 281 articles remained for full-text analysis. Ultimately, 48 articles met the inclusion criteria. Included studies report data on donor-site outcomes in patients undergoing head and neck free-flap reconstruction, including surgical complication rates.

Results: Across 48 studies that included 4230 total patients, 6 meta-analyses were conducted. Donor-site complications included seroma, hematoma, return to OR, dehiscence, and infection. Pooled incidence estimates for overall morbidity at each donor-site were found to be 14% at the radial forearm donor site, 16% at the anterolateral thigh donor site, 26% at the fibular donor site, 9% at the scapular donor site, 25% at the latissimus dorsi donor site, and 5% at the lateral arm donor site.

Conclusions: This systematic review and meta-analyses establish a comparative benchmark of donor-site morbidity for the most common donor-sites used in head and neck free-flap reconstruction. Defining these complication profiles across donor sites offers an evidence-based framework for physicians to counsel patients appropriately.