Pendulosity in regional flaps about the head and neck.

Pendulosity rarely occurs in flap transposition in the area of the head and neck. It is related to physical and physiological factors that derive from the volume of tissue transplanted, the neatness of its fit into the wound, its supportive facilities, its functional activity, its relation to gravity, and the effect of its perimeter scar tissue bed and venous drainage system. It is amazing that this condition does not appear more commonly when one considers that as much as 1,000 cc of inert tissue may be transposed as a volumetric mass, either with a singular vascular pedicle or as a singular microvascular anastomosis or a randomized soft tissue pedicle base. The difficulty is almost always compounded by the fact that the tissue does not contain a specific lymph drainage facility. The majority of these physiological handicaps, however, are accommodated by the receptiveness of the tissues of the wound and the venous drainage of the flap. If these should fail, edema and then pendulosity will occur. The condition can be improved by repositioning and a reduction in the size of the flap.