Resurgence of regional flaps for head and neck reconstruction

Abstract

Purpose of review The strain on healthcare resources in light of the COVID-19 pandemic has forced many head and neck surgeons to explore reconstructive options that may decrease length of stay. Here, we review three common and versatile regional flaps used in head and neck reconstruction that are comparable alternatives to free tissue transfer. Recent findings Initial anatomic descriptions of the facial artery musculocutaneous (FAMM) flap, the supraclavicular artery island flap and the submental artery island flap were published decades ago. Since then, many have proposed modifications to these descriptions to improve technical ease and patient outcomes. Benefits of regional flaps include ease of harvest, comparable outcomes to free tissue microvascular flaps, shorter operative time and hospital length of stay. Drawbacks to regional flaps include limitations to size and reach, partial necrosis, wound dehiscence and surgeon experience. The integrity of the vascular pedicle is also contingent upon vessel preservation during the cancer ablation. Summary Although a resurgence of regional flaps began well before the COVID-19 pandemic, many institutions began looking for alternatives to free flap reconstruction to conserve healthcare resources and minimize patient hospitalization time in the past year. There has been a revival of regional flaps such as the FAMM, supraclavicular and submental flaps that are valuable reconstructive options for many defects of the head and neck.

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

“…In addition, with the current COVID-19 pandemic situation, the more complex reconstruction with longer operative time and longer hospital stay may potentially increase risk of viral transmission. 17 18 Therefore, a variety of pedicled flaps have been performed more frequently in these situations. 8 10 17 18 Nevertheless, the difference in the cost-effectiveness of surgery involving these two types of flaps has been a matter of debate in the literature.…”

“… 17 18 Therefore, a variety of pedicled flaps have been performed more frequently in these situations. 8 10 17 18 Nevertheless, the difference in the cost-effectiveness of surgery involving these two types of flaps has been a matter of debate in the literature. 5 6 7 11 13 14 20 21 …”

“… 4 6 10 11 13 14 15 16 In addition, with the global strain on hospital resources during the COVID-19 pandemic, pedicled flaps can be a useful reconstruction in the current situation. 17 18 …”

Pandemics and facial plastics and reconstructive surgery

“…It was recommended that complex cutaneous defects be reconstructed in a staged fashion with initial treatment utilizing secondary intention healing, skin grafts or allografts, with more complex reconstruction delayed until resources were more available 15 . For larger ablative defects, increased utilization of well-established locoregional pedicled flaps was encouraged, including the pectoralis major myocutaneous, temporalis muscle, facial artery musculomucosal (FAMM), submental island (SMIF), and supraclavicular artery island flaps 15 , 16 , 17 , 18 . Delayed bony reconstruction could also be performed by using a pedicled flap with a metal reconstruction plate 15 , 18 .…”

10-Year Experience with the Modified Pectoralis Major Flap: The Use of the Deltopectoral Flap to Reduce Skin Tension

“…The muscle bulk eventually atrophies, and the muscle shrinks in the months to come after surgery giving a comparable long-term post-operative neck cosmesis outcome to the free flap reconstruction. In our study we are describing a technique that deals with the problem of initial excess muscle bulk during closure of the skin defect following the insertion of the pectoralis major flap utilising the deltopectoral fasciocutaneous flap to reduce the skin tension around the pectoralis major pedicle during skin closure [23].…”