The role and selection of local and regional pedicled flaps in head and neck reconstruction.

Abstract

Introduction: Pedicled flaps are prioritized in the free flap era for reconstruction only in institutions without sufficient microsurgical support. They are reliable for reconstruction, but with a lot of advantage, including cost, operating and hospitalization time, easy learning curve and better management of older and polymorbid patients, not suitable for the free flap reconstruction. The experience from two institutions with various types of pedicled flaps are presented in this retrospective study.

Material and methods: A total of 62 patients were enrolled in this study. With 63 flaps harvested, 1 patient underwent two reconstructions. Operations were performed in two centers. Evaluation of parameters, like age and gender of patients, indication for reconstruction, type and extent of the primary surgery, type of the pedicled flap, the primary or salvage reconstruction, complications of reconstruction and survival of flaps, was included.

Results: The median age of this cohort was 64 years (range 30-82 years) with male predominance (53 male to 9 female patients). Five groups of flaps were designed: myocutaneous, myofascial, myomucosal, fasciocutaneous and muscular flaps. Thirteen types of pedicled flaps were utilized. The most frequent flap was the infrahyoid myocutaneous flap (IHMF) in 26 patients, followed by the pectoralis major myocutaneous flap (PMMC) in 14 patients, including 15 flaps. In 1 patient, the second reconstruction was required with harvesting PMMC from the other side. Indications for reconstruction were defects after either primary or salvage surgery in 30 and 32 patients respectively. Reconstructions of the mobile tongue (13 patients) and floor of the mouth (13 patients) with IHMF predominated after primary resection in this area, followed by PMMC (three patients). In a group of defects after salvage surgery, the most frequent reconstructed area was the neck, where PMMC was preferred in 5 patients. PMMC was otherwise the most frequent type of flap utilized in salvage reconstruction (14 flaps in 13 patients). The overall cumulative flap survival was 96.8% with total flap loss in 2 patients.

Conclusion: Various flaps are favored according to institutions, however, the alternative flaps should be considered, if necessary. Pedicled flaps are still valuable options in the most of minor reconstructive centers even in well developed countries and should be reserved for reconstruction in major centers, primarily utilizing free flaps, for indicated patients, not suitable for a microsurgical reconstruction.