Zygomatic implant perforated (ZIP) flaps for maxillary reconstruction: a systematic review of flap and implant outcomes.
V T V Tran, M Mian, L Skabar et al.
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In 30 seconds
This systematic review assessed flap and implant outcomes after zygomatic implant perforated (ZIP) flap reconstruction for maxillary defects following surgical resection. Four studies contributed data on 50 patients and 50 reconstructions, with 185 zygomatic implants placed; mean follow-up was 14.3 months (IQR 12-12). The pooled flap failure rate was 4.0% (95% CI: 0.5-13.7), and the flap complication rate was 32.0% (95% CI: 19.5-46.7). Implant failure and complication rates were 2.3% and 6.9%, respectively. The authors describe overall success as high but advise caution given limited long-term evidence.
Key findings
- Flap failure was 4.0% (95% CI: 0.5-13.7), while flap complications occurred in 32.0% (95% CI: 19.5-46.7).
- Among 185 zygomatic implants, implant failure was 2.3% (95% CI: 0.6-5.8) and implant complications were 6.9% (95% CI: 3.6-11.7).
- The review included four studies covering 50 patients and 50 ZIP flap reconstructions; mean follow-up was 14.3 months (IQR 12-12).
- The review identifies prosthesis-related complications and flap-margin necrosis as additional risks specific to ZIP flaps.
Why it matters
ZIP flaps combine soft-tissue reconstruction with immediate zygomatic implants, aiming to separate the oral and nasal cavities while enabling early fixed dental rehabilitation. The reported outcomes provide an initial estimate of flap and implant risks for this approach. The complication burden, including risks involving prostheses and flap margins, is relevant when weighing reconstructive options and counselling about uncertainty.
What to keep in mind
Evidence came from only four studies, with mean follow-up of 14.3 months; the authors note a lack of long-term, high-quality studies.