Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2023; 27(01): e32-e42
DOI: 10.1055/s-0042-1751001
Original Research

Pedicled Flaps versus Free Flaps for Oral Cavity Cancer Reconstruction: A Comparison of Complications, Hospital Costs, and Functional Outcomes

Pichit Sittitrai 
1   Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
,
Donyarat Ruenmarkkaew 
1   Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
,
Hanpon Klibngern 
1   Department of Otolaryngology, Chiang Mai University hospital, Chiang Mai, Thailand
› Author Affiliations Funding The author(s) received no financial support for the research, authorship, and/or publication of the present article.
We received no specific grant from any funding agency, commercial or not-for-profit sectors, and we have no conflicts of interest to disclose.
› Further Information
   Permissions and Reprints

Abstract

Introduction Free flaps have been the preferred method for reconstruction after resection of oral cavity cancer. However, pedicled flaps remain valuable alternatives in appropriate settings.

Objective The main objective of the present study was to compare surgical complications, hospital costs, and functional outcomes of oral cavity cancer patients who underwent soft tissue reconstruction with pedicled flaps or free flaps.

Methods A total of 171 patients were included in the study. Ninety-eight underwent reconstruction with a pectoralis major, submental, temporalis, or supraclavicular pedicled flap, and in 73 patients, a radial forearm or anterolateral thigh free flap had been used. The cases were retrospectively reviewed, and a comparative analysis was carried out between the two groups.

Results Recipient site and flap complications, speech, and swallowing functions did not differ between groups, but donor site complications, operative time, hospital stay, and costs were significantly reduced in the pedicled flap group compared with the free flap group. However, the pectoralis major flap reconstruction resulted in a more inferior swallowing function than the free flap reconstruction.

Conclusions With comparable complications and functional outcomes, while decreasing in costs, pedicled flaps are a useful alternative to free flaps in oral cavity cancer reconstruction. However, in an extensive defect (> 70 cm2), free flaps are the reconstruction of choice for the preservation of swallowing function.

Keywords

pedicled flap - free flap - oral cancer - reconstruction


Publication History

Received: 06 October 2020

Accepted: 04 August 2021

Article published online:
11 July 2022

© 2023. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Kerawala C, Roques T, Jeannon JP, Bisase B. Oral cavity and lip cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130 (S2): S83-S89
    CrossrefPubMedGoogle Scholar
  • 2 Smeele LE, Goldstein D, Tsai V. et al. Morbidity and cost differences between free flap reconstruction and pedicled flap reconstruction in oral and oropharyngeal cancer: Matched control study. J Otolaryngol 2006; 35 (02) 102-107
    CrossrefPubMedGoogle Scholar
  • 3 Hsing CY, Wong YK, Wang CP. et al. Comparison between free flap and pectoralis major pedicled flap for reconstruction in oral cavity cancer patients–a quality of life analysis. Oral Oncol 2011; 47 (06) 522-527
    CrossrefPubMedGoogle Scholar
  • 4 Goyal N, Yarlagadda BB, Deschler DG. et al. Surgical site infections in major head and neck surgeries involving pedicled flap reconstruction. Ann Otol Rhinol Laryngol 2017; 126 (01) 20-28
    CrossrefPubMedGoogle Scholar
  • 5 Mallet Y, El Bedoui S, Penel N, Ton Van J, Fournier C, Lefebvre JL. The free vascularized flap and the pectoralis major pedicled flap options: comparative results of reconstruction of the tongue. Oral Oncol 2009; 45 (12) 1028-1031
    CrossrefPubMedGoogle Scholar
  • 6 de Bree R, Reith R, Quak JJ, Uyl-de Groot CA, van Agthoven M, Leemans CR. Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: a cost analysis. Clin Otolaryngol 2007; 32 (04) 275-282
    CrossrefPubMedGoogle Scholar
  • 7 Gao LL, Basta M, Kanchwala SK, Serletti JM, Low DW, Wu LC. Cost-effectiveness of microsurgical reconstruction for head and neck defects after oncologic resection. Head Neck 2017; 39 (03) 541-547
    CrossrefPubMedGoogle Scholar
  • 8 Sittitrai P, Reunmakkaew D, Srivanitchapoom C. Submental island flap versus radial forearm free flap for oral tongue reconstruction: a comparison of complications and functional outcomes. J Laryngol Otol 2019; 133 (05) 413-418
    CrossrefPubMedGoogle Scholar
  • 9 Paydarfar JA, Patel UA. Submental island pedicled flap vs radial forearm free flap for oral reconstruction: comparison of outcomes. Arch Otolaryngol Head Neck Surg 2011; 137 (01) 82-87
    CrossrefPubMedGoogle Scholar
  • 10 Gabrysz-Forget F, Tabet P, Rahal A, Bissada E, Christopoulos A, Ayad T. Free versus pedicled flaps for reconstruction of head and neck cancer defects: a systematic review. J Otolaryngol Head Neck Surg 2019; 48 (01) 13 DOI: 10.1186/s40463-019-0334-y.
    CrossrefPubMedGoogle Scholar
  • 11 Welz C, Canis M, Schwenk-Zieger S, Spiegel JL, Weiss BG, Pilavakis Y. Oral cancer reconstruction using the supraclavicular artery island flap: comparison to free radial forearm flap. J Oral Maxillofac Surg 2017; 75 (10) 2261-2269
    CrossrefPubMedGoogle Scholar
  • 12 Lakshminarayana G, Venkitachalam S, Mani CS. Choice of regional flaps for oral cancer defects: relevance in current era. J Maxillofac Oral Surg 2021; 20 (02) 246-251
    CrossrefPubMedGoogle Scholar
  • 13 Tsue TT, Desyatnikova SS, Deleyiannis FW. et al. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer. Arch Otolaryngol Head Neck Surg 1997; 123 (07) 731-737
    CrossrefPubMedGoogle Scholar
  • 14 Sukato DC, Timashpolsky A, Ferzli G, Rosenfeld RM, Gordin EA. Systematic review of supraclavicular artery island flap vs free flap in head and neck reconstruction. Otolaryngol Head Neck Surg 2019; 160 (02) 215-222
    CrossrefPubMedGoogle Scholar
  • 15 Jørgensen MG, Tabatabaeifar S, Toyserkani NM, Sørensen JA. Submental island flap versus free flap reconstruction for complex head and neck defects. Otolaryngol Head Neck Surg 2019; 161 (06) 946-953
    CrossrefPubMedGoogle Scholar
  • 16 Meier JK, Spoerl S, Spanier G. et al. Alternatives to free flap surgery for maxillofacial reconstruction: focus on the submental island flap and the pectoralis major myocutaneous flap. BMC Oral Health 2021; 21 (01) 198 DOI: 10.1186/s12903-021-01563-7.
    CrossrefPubMedGoogle Scholar
  • 17 Gray ML, Drake VE, Desai SC. Resurgence of regional flaps for head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2021; 29 (04) 237-243 DOI: 10.1097/MOO.0000000000000725.
    CrossrefPubMedGoogle Scholar
  • 18 Rashid HU, Rashid M, Khan N, Ansari SS, Bibi N. Taking a step down on the reconstruction ladder for head and neck reconstruction during the COVID-19 pandemic. BMC Surg 2021; 21 (01) 120 DOI: 10.1186/s12893-021-01134-1.
    CrossrefPubMedGoogle Scholar
  • 19 Chepeha DB, Annich G, Pynnonen MA. et al. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg 2004; 130 (02) 181-186
    CrossrefPubMedGoogle Scholar
  • 20 Vartanian JG, Carvalho AL, Carvalho SM, Mizobe L, Magrin J, Kowalski LP. Pectoralis major and other myofascial/myocutaneous flaps in head and neck cancer reconstruction: experience with 437 cases at a single institution. Head Neck 2004; 26 (12) 1018-1023
    CrossrefPubMedGoogle Scholar
  • 21 Zhang X, Li MJ, Fang QG, Sun CF. A comparison between the pectoralis major myocutaneous flap and the free anterolateral thigh perforator flap for reconstruction in head and neck cancer patients: assessment of the quality of life. J Craniofac Surg 2014; 25 (03) 868-871
    CrossrefPubMedGoogle Scholar
  • 22 Kroll SS, Evans GR, Goldberg D. et al. A comparison of resource costs for head and neck reconstruction with free and pectoralis major flaps. Plast Reconstr Surg 1997; 99 (05) 1282-1286
    CrossrefPubMedGoogle Scholar
  • 23 Li W, Zhang P, Li R, Liu Y, Kan Q. Radial free forearm flap versus pectoralis major pedicled flap for reconstruction in patients with tongue cancer: Assessment of quality of life. Med Oral Patol Oral Cir Bucal 2016; 21 (06) e737-e742
    PubMedGoogle Scholar
  • 24 Xiao Y, Zhu J, Cai X, Wang J, Liu F, Wang H. Comparison between anterolateral thigh perforator free flaps and pectoralis major pedicled flap for reconstruction in oral cancer patients–a quality of life analysis. Med Oral Patol Oral Cir Bucal 2013; 18 (06) e856-e861
    CrossrefPubMedGoogle Scholar
  • 25 Zhang S, Chen W, Cao G, Dong Z. Pedicled supraclavicular artery island flap versus free radial forearm flap for tongue reconstruction following hemiglossectomy. J Craniofac Surg 2015; 26 (06) e527-e530
    CrossrefPubMedGoogle Scholar
  • 26 Deganello A, Gitti G, Parrinello G, Muratori E, Larotonda G, Gallo O. Cost analysis in oral cavity and oropharyngeal reconstructions with microvascular and pedicled flaps. Acta Otorhinolaryngol Ital 2013; 33 (06) 380-387
    PubMedGoogle Scholar
  • 27 Sinha S, Puram SV, Sethi RK. et al. Perioperative deep vein thrombosis risk stratification. Otolaryngol Head Neck Surg 2017; 156 (01) 118-121
    CrossrefPubMedGoogle Scholar
  • 28 Forner D, Williams BA, Makki FM, Trites JR, Taylor SM, Hart RD. Late free flap failure in head and neck reconstruction: A systematic review. Ear Nose Throat J 2018; 97 (07) 213-216
    CrossrefPubMedGoogle Scholar
  • 29 Wang W, Ong A, Vincent AG, Shokri T, Scott B, Ducic Y. Flap failure and salvage in head and neck reconstruction. Semin Plast Surg 2020; 34 (04) 314-320
    Article in Thieme ConnectPubMedGoogle Scholar