One-stage tunneled de-epithelialized deltopectoral flap for huge head and neck cancer defects in the era of free flaps.

Objective: The deltopectoral (DP) flap was and still is a workhorse flap in the reconstruction of head and neck defects following tumor resection, even in the current era of free microvascular flaps.

Material and methods: We retrospectively recruited, from a prospectively maintained database, all patients with a history of defect reconstruction using one-stage tunneled de-epithelialized fasciocutaneous DP flap following resection of head and neck cancer between June 2020 and June 2023. Patient and disease characteristics, surgery parameters, flap specifics, oncological outcomes, and follow-up data were analyzed and reported.

Results: Eleven patients were recruited; 6 of them were females (54.54%). Head and neck squamous cell carcinoma is the most common pathology (54.5%), followed by papillary carcinoma of the thyroid gland (27.3%). Six patients were operated upon for recurrences, and tumor fungation and/or ulceration was reported in 81.8%. The median age at the time of flap reconstruction was 71 years (range: 46.5-77). Wound complications were reported in 36.4% of patients, with the overall rate of flap necrosis being 27.3%, including 3 patients who suffered from major necrosis at the distal 1/3 of the flap. No delay in receiving adjuvant therapies, according to treatment protocols, was reported for any of the surviving patients.

Conclusion: The one-stage tunneled de-epithelialized fasciocutaneous DP flap is an effective choice with acceptable outcomes for defect reconstruction following resection of locally advanced head and neck cancer, whether on a curative or palliative basis, in relatively old patients with different comorbidities who require rapid treatment sequencing.