Background: The purpose of this meta-analysis was to compare the surgical outcomes of head and neck reconstruction via free flap surgery, with neck vessels versus superficial temporal vessels as recipient vessels.

Methods: The PubMed, Embase, and Scopus databases were systematically searched via the following keywords: ("superficial temporal" OR "temporal") AND ("free flap" OR "free tissue transfer") AND ("head and neck" OR "face"). The following data were extracted: first author, publication year, flap type, reconstruction region, concordant vein graft, recipient vessel, and postoperative complications, including thrombosis, partial necrosis, and flap failure. The recipient vessels were divided into two groups: the superficial temporal artery (STA)/V group and the neck group.

Results: Six hundred and thirty-five studies that met the inclusion criteria were included and reviewed systematically for a meta-analysis. Compared with the neck vessel group, the STA/V vessel group had a significantly greater risk of flap failure (odds ratio: 2.18; 95% CI: 1.32-3.60; p = 0.002), with low heterogeneity (p = 0.84; I2 = 0%). However, there were no significant differences in the rates of thrombosis or partial necrosis.

Conclusions: Compared with the use of neck vessels, the use of STA/V vessels as recipient vessels for head and neck reconstruction could increase the risk of total flap necrosis. Considering these findings, surgeons should exercise caution when selecting the STV as the recipient site, and as some authors have suggested, proximal dissection may be necessary during surgery.