Abstract
ObjectiveThe present review focuses on comparative studies of reconstruction with free flaps (FF) versus pedicled flaps (PF) after oncologic resection.MethodA systematic review was developed in compliance with PRISMA guidelines and performed using the Pubmed, Medline, EMBASE, Amed and Biosis databases.ResultsA total of 30 articles were included. FF are associated with a longer operative time, a higher cost and a higher incidence of postoperative revisions compared to PF. FF are associated with a longer stay at the intensive care unit than the supraclavicular artery island flap (SCAIF) and with a more extended hospital stay compared to the submental island flap (SMIF). FF are associated with fewer infections and necrosis compared to the pectoralis major myocutaneous flap (PMMF).ConclusionThe comparison of both type of flaps is limited by the inherent design of the studies included. In sum, FF seem superior to the PMMF for several outcomes. SMIF and SCAIF compare favorably to FF for some specific indications achieving similar outcomes at a lower cost.
Highlights
Head and neck reconstruction surgery has considerably evolved over the past decades, along with the trend of using either a free or a pedicled flap for the reconstruction of oncologic defects
The major findings of the present study are that: (a) Free flap (FF) was associated with a longer operating time and, in general, a higher cost compared to pedicled flap (PF), including compared to supraclavicular artery island flap (SCAIF). (b) FF was associated with a lower hospitalization stay compared to pectoralis major myocutaneous flap (PMMF), but a higher hospitalization stays when compared to SCAIF and submental island flap (SMIF). (c) Recipient site morbidity was lower with FF reconstruction compared to PMMF, including a lower incidence of infection, dehiscence, and necrosis
The incidence of hematoma and fistula were equivocal. (d) Donor site morbidity was equivocal between FF and PF reconstruction, with no distinction in the rate of infection, dehiscence, and hematoma. (e) Revision surgery was higher with FF reconstruction compared to PF and SMIF. (f ) Speech quality was better with FF than with PMMF for oral cavity defects, and FF and PMMF scored on global quality of life, pain, swallowing, chewing, speech, activity, recreation, taste, saliva, anxiety and composite score
Summary
Head and neck reconstruction surgery has considerably evolved over the past decades, along with the trend of using either a free or a pedicled flap for the reconstruction of oncologic defects. Tracing back the history of flaps, the first pedicled flap (PF) was described by Susruta in 800 BC and consisted of a forehead flap [1]. It was later popularized by McGregor in 1963 and marked a turning point in reconstructive surgery, being the first ever reliable transposition flap [2]. Free flap (FF) reconstruction slowly gained popularity over time to become the standard of care for large head & neck defects
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