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
Bibliographical Record boom dos retalhos livres? Avaliação de 269 casos em um centro de nível 4. Revista Brasileira
de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Surgery 2025; 40: s00451811180.
