Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis

Joshua Barlow, Zara Sragi, Nina Rodriguez, Mathilda Alsen, Catharine Kappauf, Rocco Ferrandino, Susmita Chennareddy, Tamar Kotz, Diana N. Kirke, Marita S. Teng, Eric M. Genden, Mohemmed N. Khan, Scott A. Roof

Research output: Contribution to journalReview articlepeer-review


Background: Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6–14 days post-operatively due to concern for orocutaneous fistula development. Methods: Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. Results: One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = −0.02, p = 0.06) or free flap failure (RD = −0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = −2.43, p < 0.01). Conclusions: While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.

Original languageEnglish
Pages (from-to)1224-1233
Number of pages10
JournalHead and Neck
Issue number5
StatePublished - May 2024


  • early feeding
  • free flap reconstruction
  • meta-analysis
  • oral cavity cancer
  • systematic review


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