Postoperative shoulder dysfunction following latissimus dorsi versus pectoralis major flap reconstruction

Monday, October 13, 2025

4:36 PM - 4:42 PM EDT

Location: 127

Introduction: Shoulder dysfunction is a significant and likely underappreciated source of morbidity following major head and neck surgery with pedicled or free tissue reconstruction. Here, we report the preliminary findings of a retrospective study evaluating postoperative shoulder function among patients who underwent head and neck reconstruction with pedicled pectoralis major flaps (PPMF) versus latissimus dorsi flaps (LDF).

Methods: This was a retrospective study of patients who underwent major head and neck surgery at the University of Michigan prior to January 1, 2024. Patients were included if their reconstruction included PPMF, pedicled LDF, or free LDF +/- chimeric scapular bone. Patients were excluded if they were lost to follow up within a year of surgery or had missing postoperative data. Electronic medical records were queried for patient data. Descriptive and univariable analyses were performed using STATA/BE 17.0. The results of an ongoing prospective arm to this study evaluating patient-reported outcomes are pending.

Results: 52 patients who underwent surgery from 2010-2023 met inclusion and exclusion criteria. 73.1% (n=38) were male, 75% (n=39) were Caucasian, and the mean age was 56 years. Surgical indications included larynx cancer (9.7%; n=7), oral cavity cancer or mandibular defects (42.3%; n=22) , and scalp defects (9.7%; n=7). 13.4% (n=7) underwent PPMF, 48.1% (n=25) free or pedicled LDF, and 38.5% (n=20) chimeric LD-scapular tip free flaps. 86.5% (n=45) experienced immediate shoulder dysfunction. Among the affected, 32.7% (n=17) attained normal shoulder function within a year. No association between age, sex, or race and shoulder dysfunction was detected (p=0.33, 0.08, and 0.42, respectively). Patients with PPMF and chimeric LD-scap flaps were more likely to experience shoulder dysfunction than those with LDF (p=0.013). Immediate shoulder dysfunction was more common in patients with pedicled flaps (100% vs 79.4%; p=0.04).

Conclusions: Our preliminary results suggest that pedicled flaps and flap donor site influence postoperative shoulder morbidity following major head and neck surgery.

Presenting Author(s)

RT

Raisa O. Tikhtman, MD

Resident Physician
University of Cincinnati Department of Otolaryngology-Head and Neck Surgery
Cincinnati, Ohio, United States

Disclosure information not submitted.

Co-Author(s)

Dena B. Hasan

Study Coordinator
University of Michigan Department of Otolaryngology-Head and Neck Surgery
Lambertville, MI, United States

Disclosure information not submitted.
RG

Rebecca W. Gao, MD

Resident
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
Marisa R. Buchakjian, MD, PhD

Assistant Professor
University of Michigan
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Keith A. Casper, MD

Associate Professor
University of Michigan Otolaryngology
Ann Arbor, MI, United States

Disclosure information not submitted.
Steven B. Chinn, MD

Associate Professor
University of Pittsburgh Medical Center
Pittsburgh, PA, United States

Disclosure information not submitted.
DF

David WA Forner, MD MSc FRCSC

Assistant Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
KM

Kelly Michele Malloy, MD, MBA, FACS

Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
Mark P. Prince, MD

Professor and Chair, Otolaryngology/Head and Neck Surgery
University of Michigan Otolaryngology
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
CS

Chaz Stucken, MD

Associate Professor of Otolaryngology-Head and Neck Surgery
University of Michigan
Ann Arbor, Michigan, United States

Disclosure information not submitted.
PY

Pratyusha Yalamanchi, MD MBA

Head and Neck and Microvascular Surgery Fellow
Vanderbilt University Medical Center
Rochester Hills, MI, United States

Disclosure information not submitted.

Senior Author(s)

Molly E. Heft Neal, MD

Assistant Professor
University of Michigan
Ann Arbor, MI, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.