Improving head and neck reconstruction with a modified pedicled flap

Sometimes, moving just a few inches can go a long way.

Osaka Metropolitan University researchers have developed a promising technique for head and neck reconstruction that shifts the placement of transferred tissue with blood vessels attached, offering a safer, faster option for patients with complex tissue defects, especially those at high risk.

Head and neck reconstruction plays a crucial role in the treatment of patients with head and neck cancer. The goal is to preserve functions vital for breathing, eating, and speaking, while maintaining the patient’s appearance and quality of life.

“Traditional reconstruction typically uses free flaps, which may not be feasible for some patients, such as those who have had prior radiation treatment or multiple surgeries,” said Tsubasa Kojima, a medical doctor and lecturer at Osaka Metropolitan University’s Graduate School of Medicine and lead author of the study.

A free flap is a section of tissue that is fully detached from a healthy part of the body (donor site) and reattached to new blood vessels at the defect (recipient site).

The research team cut a new path and worked instead with pedicled flaps taken from the back, called pedicled latissimus dorsi (LD) myocutaneous flaps. Unlike free flaps, pedicled flaps remain partially attached to the donor site, retaining their natural blood supply as they are transferred to the recipient site for reconstruction.

While the LD flap has been used in various reconstructive surgeries, the team developed a unique approach that placed the skin portion of the LD flap more distally, or lower on the back, than in conventional techniques. This design includes the lateral cutaneous branch of the 10^th posterior intercostal artery, ensuring reliable blood flow to the flap.

This setup provides flexibility, allowing the LD flap to cover extensive defects, including those in both the mouth and neck simultaneously, and even facilitates jaw reconstruction by incorporating rib bone.”

Tsubasa Kojima, Graduate School of Medicine, Osaka Metropolitan University

The study, conducted between 2003 and 2024, demonstrated that the pedicled LD flap was successfully integrated in all 22 patients with complex head and neck defects.

“Our results suggest that this pedicled LD flap technique provides a reliable, fast, and minimally invasive option for head and neck reconstruction, particularly in cases where free flaps are not suitable,” Kojima said. “We hope this approach will significantly improve treatment outcomes for patients undergoing head and neck reconstruction.”

Their findings were published in Plastic and Reconstructive Surgery-;Global Open.