Pedicled and free latissimus dorsi flaps in oral and oropharyngeal reconstruction: comparison of outcomes.

Source: PubMed, NCBI / U.S. National Library of Medicine

The aim was to evaluate the reconstruction of multiple anatomical functional units using a single latissimus dorsi flap. In this retrospective study, 280 latissimus dorsi flaps raised using a two-team approach in the supine position without patient repositioning were analysed. The number and location of the anatomical units being reconstructed and their epidemiological, oncological, surgical, and flap-related parameters were also analysed. Of the 280 latissimus dorsi flaps, 144 were pedicled, and 136 were raised as free flaps, with no statistically significant difference in the total flap necrosis rates; risk factors for complications, such as diabetes mellitus, arterial hypertension, and chronic alcohol abuse, did not increase the risk of flap necrosis. Free flaps showed better outcomes in upper maxillofacial region reconstruction. Therefore, free and pedicled latissimus dorsi flaps are reliable options for extended maxillofacial and oral cavity reconstructions. However, partial flap necrosis increases when more than two functional anatomic units are reconstructed simultaneously (P = 0.040), suggesting the consideration of multiple soft-tissue island flaps.