Reconstructive options in patients with late complications after surgery and radiotherapy for head and neck cancer: remember the deltopectoral flap.

During the past 40 years, free vascularized flaps have become the golden standard in the reconstruction of postoncologic head and neck defects. When there is a need for an osteofasciocutaneous free flap, the free fibula flap is the first choice because of the advantages of its long bone structure, high reliability, and minimal donor-site morbidity. However, most of these patients receive adjuvant radiation therapy, which sometimes causes symptomatic fibrosis, contractures, and (osteo)radionecrosis. In case of these late complications, locoregional reconstructive options are often limited, and complex secondary free flap procedures are not always feasible or preferred by the patient. The present paper discusses regional and free flap reconstructive options and demonstrates with 3 cases that the delayed deltopectoral flap remains a very safe, reliable, and easy flap, which still has a place in the management of these complex reconstructive challenges.