Personalized Strategies for Head and Neck Reconstruction Using Pedicled Flaps

TL;DR

This study examines the use of pedicled flaps for head and neck reconstruction when free flaps are not suitable, finding that they remain a viable option with low complication rates.

Contribution

The study provides a detailed analysis of pedicled flap strategies and complication rates in head and neck reconstruction.

Findings

Pectoralis major flaps were most commonly used for tongue and hypopharyngeal reconstruction.

Pedicled flaps had low complication rates, including 11.6% partial flap necrosis and 12.5% wound dehiscence.

Pharyngeal stenosis occurred in only 0.9% of cases, indicating good functional outcomes.

Abstract

Background/Objectives: In recent decades, free flaps have emerged as the gold standard for head and neck reconstruction. However, their use is contraindicated in some cases due to advanced age and/or comorbidities. In such patients, a pedicled flap may be considered. The aim of this observational study was to evaluate strategies for head and neck reconstruction using pedicled flaps in the era of free flaps. Furthermore, the complication rate was analyzed. Methods: Patients who underwent head and neck reconstruction with pedicled flaps were included. The following flaps were considered: the pectoralis major (PMF), deltopectoral, platysma, frontal, temporal, nasolabial, supraclavicular artery island (SCAIF), infrahyoid, sternocleidomastoid, buccal fat pad, and facial artery myomucosal flap (FAMM). Patients’ characteristics, flap type, recipient sites, and flap-related complications were systematically recorded. Results: A total of 112 pedicled flaps were analyzed. A PMF was most commonly used for tongue and hypopharyngeal reconstruction. Partial and complete flap necrosis occurred in 11.6% and 1.8% of cases, respectively. Wound dehiscence was reported in 12.5% of cases, while pharyngo-/oro-cutaneous fistulas developed in 6.3% of patients. Hemorrhage from the donor site or flap occurred in 3.6% of cases, and pharyngeal stenosis in 0.9%. Conclusions: Each reconstructive strategy depends on the site and extent of tissue loss. Given the low complication rates, pedicled flaps remain a valid option for head and neck reconstruction in selected patients.

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