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Sequential flaps reconstruction in head and neck cancer: A systematic review
Yu Xiong1, Zepeng Xu2, Mailudan Ainiwaer1
1Sichuan University, West China Hospital, Department of Otolaryngology, Head and Neck Surgery, Chengdu, China; Sichuan University, West China Hospital, Head and Neck Surgical Center, Chengdu, China.
Brazilian Journal of Otorhinolaryngology
|July 30, 2025
Summary
Sequential flaps offer an effective reconstructive option for head and neck cancer (HNC) patients requiring additional tissue. This systematic review found a 5.4% flap failure rate, highlighting their utility despite potential complications.
Area of Science:
- Reconstructive Surgery
- Head and Neck Oncology
- Microsurgery
Background:
- Flap reconstruction is vital for large head and neck cancer (HNC) defects.
- While initial flaps suffice for many, some patients need secondary or sequential flaps.
- The efficacy and outcomes of these subsequent reconstructions require systematic evaluation.
Purpose of the Study:
- To systematically review and investigate the application of sequential flaps in HNC reconstruction.
- To analyze outcomes including operation duration, hospitalization, flap complications, and success rates.
Main Methods:
- A systematic literature search was conducted across PubMed, EBSCO, and Web of Science.
- Two independent reviewers screened articles based on predefined inclusion criteria.
- Data extraction focused on operation/hospitalization duration, flap complications, and success rates.
Main Results:
- Seventeen articles involving 832 patients and 1037 sequential flaps were analyzed.
- The overall flap failure rate was 5.4%.
- Common complications included revision (5.8%), complete flap necrosis (5.2%), and thrombosis (3.3%).
Conclusions:
- Sequential flaps represent a viable and effective reconstructive strategy for HNC patients.
- Further prospective research is needed to identify prognostic factors and optimize patient selection.
- Preoperative counseling must manage patient expectations regarding functional and aesthetic outcomes.
