Head and neck reconstruction with pedicled flaps in the free flap era.
Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis.
Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.|University of Groningen, University Medical Center Groningen, the Netherlands.
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R
Mahieu
Department of Maxillo-facial Surgery, University of Milan, Milan, Italy.
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G
Colletti
Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
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P
Bonomo
Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
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G
Parrinello
Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
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A
Iavarone
Department of Oncologic Surgery l'institut de Cancérologie de Lorraine, Nancy, France.
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G
Dolivet
Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
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Livi
Department of Surgery and Translational Medicine, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Italy.
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Deganello
D005260:Female; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps
Free flap; Head and neck cancer; Head and neck reconstruction; Oral cavity reconstruction; Pedicled flap