Pedicled versus Free Flaps in Head and Neck Reconstruction: A Comparative Review

Abstract

Introduction: The choice between pedicled and free flaps for head and neck reconstruction remains debated. This literature review compares outcomes, complications, and functional results between these two techniques.

Methods: A comprehensive search of MEDLINE and Embase identified comparative studies and case series. Inclusion criteria: adult patients undergoing head and neck reconstruction for oncologic or traumatic defects. Outcomes measured included flap survival, operative time, length of stay, and speech/swallowing function.

Results: Thirty-eight studies were analyzed. Free flap success rates exceeded 95%, while pedicled flap success rates ranged from 90% to 94%. Operative time was significantly longer for free flaps (mean difference 2.5 hours). Hospital stay was similar. Speech and swallowing outcomes favored free flaps for large oropharyngeal defects. Donor-site morbidity was higher with pedicled flaps.

Discussion: Free flaps offer superior versatility and reliability for complex defects, albeit with longer operative times. Pedicled flaps remain useful for moderate defects or when microsurgical expertise is unavailable. Patient selection should guide technique choice.

Conclusions: Both techniques are viable. Free flaps are preferred for extensive defects; pedicled flaps are suitable for less complex cases. Surgeon experience remains a critical factor.