Head and Neck Reconstruction with Distant Axial and Pedicled Flaps: Summarizing the Options. Systematic Review of the Literature.
Head and neck oncologic reconstruction requires adaptable flaps to restore function and esthetics. The systematic review assesses the efficacy and complications of five distant axial pedicled flaps (DAPF): pectoralis major myocutaneous flap (PMMF), supraclavicular artery island flap (SAIF), deltopectoral flap (DPF), trapezius muscle flap (TMF), and latissimus dorsi pedicled flap (LDPF).
Adhering to PRISMA guidelines, we reviewed data from 131 studies encompassing 5481 patients. Inclusion criteria were limited to studies evaluating adult head and neck cancer patients reconstructed with one of the five options. Parameters analyzed included size, location, early and late complications, functional and aesthetic outcomes.
PMMF was the most frequently used flap (77%), covering an average defect size of 67.7 cm2, and proved effective for extensive and complex reconstructions. Both SAIF and DPF flaps were advantageous for medium defects, with SAIF showing superior aesthetic satisfaction and low complication rates (2%). PMMF had higher dehiscence rates (9%) and flap necrosis (< 1%).
Pedicled flaps offer reliable reconstructive options when free flaps are contraindicated. PMMF is optimal for large defects, while SAIF is preferred for medium defects prioritizing aesthetics. Other options are rarely contemplated. Future studies should aim to standardize outcome measures and investigate long-term functional outcomes.
Adhering to PRISMA guidelines, we reviewed data from 131 studies encompassing 5481 patients. Inclusion criteria were limited to studies evaluating adult head and neck cancer patients reconstructed with one of the five options. Parameters analyzed included size, location, early and late complications, functional and aesthetic outcomes.
PMMF was the most frequently used flap (77%), covering an average defect size of 67.7 cm2, and proved effective for extensive and complex reconstructions. Both SAIF and DPF flaps were advantageous for medium defects, with SAIF showing superior aesthetic satisfaction and low complication rates (2%). PMMF had higher dehiscence rates (9%) and flap necrosis (< 1%).
Pedicled flaps offer reliable reconstructive options when free flaps are contraindicated. PMMF is optimal for large defects, while SAIF is preferred for medium defects prioritizing aesthetics. Other options are rarely contemplated. Future studies should aim to standardize outcome measures and investigate long-term functional outcomes.
Authors
Accorona Accorona, Cremasco Cremasco, Dallari Dallari, Gazzini Gazzini, Micolitti Micolitti, di Furia di Furia, Mevio Mevio, De Virgilio De Virgilio, Iftikhar Iftikhar, Calabrese Calabrese, Dragonetti Dragonetti, Gazzini Gazzini
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