Free flap versus pedicled flap reconstruction in head and neck surgery: A systematic review and meta-analysis.
Free flap head and neck reconstruction takes much longer than pedicled flap surgery.
Free flap versus pedicled flap reconstruction in head and neck surgery: A systematic review and meta-analysis.
Free and pedicled flaps remain the principal reconstructive options following head and neck oncologic surgery.
A systematic search of PubMed and Embase was conducted from database inception to September 2025, following PRISMA guidelines.
free flap surgery takes far longer than pedicled flap surgery
Twenty-five studies met inclusion criteria.
Hospital stay was similar between groups (mean difference = +0.6 days; 95% CI -2.7 to +3.9).
Pedicled flaps exhibited slightly fewer overall complications, including wound dehiscence, infection and revision surgery.
Flap failure was significantly more frequent with free flaps.
Free flaps remain the standard for extensive or functionally demanding reconstructions, but pedicled flaps offer comparable outcomes with shorter surgery, lower costs and equivalent complication rates in selected cases.
Flap choice should be individualised based on defect complexity, patient comorbidity and institutional expertise.