Pedicled versus free flap reconstruction in head and neck surgery: analysis of complications and quality of life.

purposeThis study aims to systematically compare free flaps and pedicled flaps in patients with head and neck cancer. By tracking postoperative complications, psychosocial adaptation, and quality of life through long-term follow-up, this research seeks to provide evidence-based, individualized flap repair strategies to reduce complications and improve overall treatment outcomes and quality of life.

methodsIn this single-center, clinical data of head and neck cancer patients undergoing flap reconstruction (2018–2024) were retrospectively extracted. Psychological and quality-of-life outcomes were prospectively collected at 1, 3, and 6 months postoperatively using validated scales (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Head and Neck Module 35, Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale). Variables were selected based on clinical relevance. The Mann-Whitney U test, chi-square test, Univariate and multivariate logistic regression analyses were conducted to evaluate the risk factors for postoperative complications and length of hospital stay after flap reconstruction.

resultsAmong 736 head and neck cancer patients undergoing flap reconstruction, 178 (24.2%) and 558 (75.8%) received free and pedicled flaps, respectively. Complications occurred in 234 (31.8%) of patients, with flap-related and systemic complications accounting for 127 (17.3%) and 155 (21.1%). Multivariate logistic regression analysis identified Prothrombin time (OR = 1.26, 95% CI [1.01–1.58], p = 0.037) as a significant predictor of flap-related complications. Hypertension (OR = 1.85, 95% CI [1.22–2.82], p = 0.0039) increases the risk of systemic complications. Surgical duration exceeding three hours (OR = 2.4, 95% CI [1.21–4.79], p = 0.012; OR = 1.75, 95% CI [1.01–3.04], p = 0.045), N3 stage (OR = 1.76, 95% CI [0.74–4.17], p = 0.2; OR = 3.2, 95% CI [1.47–6.95], p = 0.00341) experience a higher incidence of both flap-related and systemic complications. Psychological health assessments showed that the pedicled flap group had significantly higher Zung Self-Rating Depression Scale score than the free flap group at both three and six months post-surgery (42.3 ± 6.1 vs. 40.1 ± 7.3, p = 0.025; and 44.7 ± 5.5 vs. 41.6 ± 6.7, p = 0.002, respectively). Evaluations using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Head and Neck Module 35 scales confirmed that flap type did not affect any quality of life dimension.

conclusionThis study identified predictors of postoperative flap-related complications in head and neck reconstruction, including prolonged prothrombin time, surgery duration exceeding 3 h, hypertension, and advanced T stage. Furthermore, it revealed that patients receiving pedicled flaps reported higher postoperative depression scores, highlighting the importance of psychological considerations in surgical planning. Collectively, these findings provide a multidimensional evidence base for developing personalized preoperative reconstruction strategies.