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The evolving role of free flaps and pedicled flaps in head and neck reconstruction

Hayden, Richard E.; Nagel, Thomas H.

Current Opinion in Otolaryngology & Head and Neck Surgery: August 2013 - Volume 21 - Issue 4 - p 305–310
doi: 10.1097/MOO.0b013e328362ceef

Purpose of review This article reviews literature pertaining to the evolution in head and neck reconstruction techniques over the past two decades, specifically the changing patterns of usage of locoregional flaps and microvascular free tissue transfer.

Recent findings Most literature demonstrates a continuing trend favoring microvascular free tissue transfer for the majority of large defects. A few pedicled flaps, some new and some resurrected, now provide expanded and sometimes superior options for certain head and neck defects. Considerations driving flap choice include defect composition, oncologic, aesthetic, and functional factors.

Summary Although osteocutaneous microvascular free flaps remain the standard of care for composite oromandibular defects, there may be a groundswell in the use of certain locoregional pedicled flaps for reconstructing many facial, intraoral and pharyngeal soft tissue defects. Evolution in the use of these locoregional flaps may help improve upon the standard of care for reconstructive options.

Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA

Correspondence to Richard E. Hayden, MD, Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. Tel: +480 342 2912; fax: +480 342 2626; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins