Anterolateral Thigh Flap and Bone Plate for Mandibular Reconstruction in Patients over 55 Undergoing Ablative Oral Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making.