FAMM flap in oral cavity and tongue defect reconstruction: A systematic review and meta-analysis

Background: The facial artery musculomucosal (FAMM) flap is a versatile flap based on the facial artery. It can be used to reconstruct the floor of the mouth, palate, tongue and alveolar ridge. The flap can be designed in various orientations and modified as an islanded or tunnelised flap. This study aimed to review the application of FAMM flap in the reconstruction of defects of the tongue and oral cavity, with specific focus on success rates and total complications. Methods: A literature search was conducted by 2 independent reviewers on PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal (BMJ) electronic databases (Registry CRD42024529989). Results: Twenty-seven studies fulfilled the search criteria and data on 407 FAMM flaps performed on 402 patients were extracted for analysis. Overall, 1.7% (n=7) of flaps failed because of total necrosis (n=3), partial necrosis requiring surgical intervention and flap abandonment (n=2), total failure (n=1) and fistula formation (n=1). Overall, 26.0% (n=106) of patients experienced non-functional complications. The most reported complications were partial necrosis (n=23, 5.7%), wound dehiscence (n=18, 4.4%) and venous congestion (n=13, 3.2%). The pooled success rate in all studies using FAMM flaps for oral cavity and tongue reconstruction was 99.47% (95% CI, 98.26 to 100.00, P = 1.00; I-2 = 0%;). Pooled total complication rates were 30.18% (95% CI, 16.97 to 43.38, P < 0.01; I-2 = 91%). Only 35 flaps required re-operation. Conclusions: With low complication and failure rates, FAMM flaps are a safe and versatile option to consider in oral cavity and tongue reconstruction. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).