Are Regional Flaps Still an Adequate Reconstruction Strategy for Head and Neck Tumors in the Era of the Boom for Free Flap? Evaluation of 269 Cases in a 4-Level Center

Abstract

Introduction

There is a current trend towards microsurgical flaps, replacing pedicled flaps in reconstruction of large locoregional defects after head and neck surgery. We reviewed the use of both techniques in reconstruction to establish the role of the non-microvascular flaps.

Materials and Methods

A retrospective cross-sectional study was conducted. Statistical analysis included means and standard deviations (SD), absolute and relative frequencies, bivariate analysis correlation, and a binary logistic regression. Statistical significance was defined with p < 0.05, and 95% confidence interval (CI).

Results

A total of 269 patients were reviewed, with 105 women and 164 men, and a mean age of 62.5 years. The majority had squamous cell carcinoma located in oral cavity and oropharynx, most being stage IV (77%). Regional flaps were used in 70.6% and microvascular in 29.4% of the cases. Overall morbidity was 16%, mortality 6.7% (all stage IV, > 70 years old). Bivariate analysis exhibited intermediate correlation between older age and greater morbidity, low correlation between advanced stages and more frequent use of microsurgical flaps, no correlation between morbidity and type of flap or clinical stage, and high correlation between patients over 70 years old and postoperative mortality. Logistic regression showed that microsurgical flaps had 2.8 times higher chance of morbidity and males had 2.7 times higher risk of mortality, which increased to 18.5 times in cases with postoperative morbidity.

Conclusion

Currently, even with the preference towards free flaps, pedicled ones should not be dismissed, as they can offer similar results, including lower morbidity, surgical time, and health care costs.

Keywords

free-tissue flaps - head and neck neoplasms - mandibular reconstruction - microsurgery - surgical flaps

Financial Source

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

Publikationsverlauf

Eingereicht: 06. April 2025

Angenommen: 20. Mai 2025

Artikel online veröffentlicht:
10. September 2025

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