The Utilization of Locoregional Flaps in Extensive Head and Neck Reconstruction as a Salvage Option and in Supplementation of Free Flaps-A 10-Year Experience

Background:Free tissue transfer has supplanted the locoregional flap treatment in major head and neck reconstruction surgery. However, the locoregional flap procedure remains relevant, especially in the context of failed free flaps, palliative management or comorbidities present significant risk to free tissue transfer.Aim and Objectives:The objective of this study was to examine the indications and use of locoregional flaps in a high-volume unit performing free tissue transfers.Materials and Methods:From January 2001 to December 2009, thirty locoregional flaps were used for reconstruction on 28 patients. Twenty-four pectoralis major flaps and 6 deltopectoral flaps were used. The relevant patient demographic data collected included patient history, indications, prior surgeries and adjuvant treatment. Outcome measurements, including complications, infections, and necrosis, were reviewed.Results: Fifteen flaps were performed for immediate reconstruction after tumor ablation, with 3 as supplement to free tissue transfer. Another fifteen flaps were used as salvage procedures following failed free flaps, including two local flaps performed on one patient simultaneously due to the absence of recipient vessels. In addition, one flap suffered from a deep neck infection and resulted in complete flap loss. However, the second local flap survived. The overall success rate was 96.7%. All patients tolerated well to their donor sites.Conclusion:Locoregional flaps remain a viable option for salvage procedures in head and neck reconstruction. These procedures are especially useful when scarcity of good recipient vessels prohibit the for free flap option. As a first line treatment, the complex defects that are too extensive for treatment with single flaps may also benefit from the superior color match of an additional locoregional flap as its external surface.