Ariana Shaari
Rutgers, New Jersey, United States

The history of head and neck reconstruction is as rich as it is complex. Reconstructive techniques in this domain are broadly categorized as local pedicle flaps, regional flaps, and free flaps.¹ These methods trace their origin to ancient practices, with renowned surgeon Sushruta’s use of the forehead flap for nasal reconstruction in 700 BC being one of the earliest documented examples.² Over centuries, these approaches have evolved into modern techniques, with multiple iterations of free tissue transfer to reconstruct the face following trauma or ablation. Among these, the inceptionof the tubed pedicle flap was pivotal and the primary reconstructive method for large defects of the skin through the 1970s.^1,3 The credit for this technique remains debated, with notable contributions from four surgeons: John Law Aymard, Vladimir Petrovich Filatov, Hugo Ganzer, and Harold Gillies.¹ This essay focuses on Filatov’s use of the tubed pedicle flap and its lasting impact on reconstructive surgery.

Vladimir Petrovich Filatov (1874–1956) was an ophthalmologist from Odessa, Ukraine.^1,4 In 1914, Filatov began investigating the utility and efficacy of the tubed pedicle flap by conducting animal studies in rabbits. He demonstrated that pedicle circulation was sustained by neoangiogenesis, a concept that highlighted the flap’s viability even when detached from its original vascular bed.¹ On September 9, 1916, he performed the first recorded use of a tubed pedicle flap in the reconstruction of a lower eyelid defect (Figure 1).^1,5-7 To ensure adequate perfusion, he confirmed capillary refill with small incisions in the flap.¹ Filatov kept the pedicle with the goal of reinserting it later into the neck, but the patient preferred to have it removed. These meticulous techniques not only ensured survival of the flap, but also set the foundation for subsequent refinements in pedicle-based reconstruction. In 1959, Filatov published “Plastic Procedure Using a Round pedicle,” a landmark article detailing his methodology and results.⁸

 The tubed pedicle flap became the primary reconstructive method for large defects through the mid-twentieth century. Its versatility permitted surgeons to address complex reconstructions. The technique became particularly valuable during World War 1 in the reconstruction of battle injuries, particularly of the face.⁹ While multiple surgeons made notable contributions to the inception of the flap,Filatov’s meticulous documentation and technical innovations cemented his legacy in reconstructive surgery. Modern head and neck reconstruction has advanced significantly and relies heavily on microvascular reconstruction for larger and more extensive defects. However, tubed pedicle flaps are still utilized in some salvage procedures such as certain hand and facial wounds.^1,10

The chronologic progression of head and neck reconstruction reflects an interplay between innovation and tradition. Vilatov’s original tubed pedicle flap demonstrates a transformative approach that bridged the gap between ancient reconstructive techniques and modern surgical advances. While contemporary head and neck reconstruction relies predominantly on microvascular free flaps, principles established by pioneers such as Filatov remain embedded in surgical practice.¹⁰ The legacy of the tubed pedicle flap and illustrations surrounding its context underscore the importance of historical innovations in shaping the future of reconstructive surgery, and knowledge of these origins can help influence new reconstructive options.

References

1. The Tubed Pedicle Flap Centennial: Its Concept, Origin, Rise and Fall. Eur J Plast Surg. 2017;40(5):427-434. https://doi.org/10.1007/s00238-017-1289-8.
2. Jain SA, Bajantri B, Jagtap R. Tubed pedicle flap: revisiting an old classic. J Med Trop. 2022;24(3):176-180. doi:10.4103/jomt.jomt_57_22.
3. Potparic Z, Jackson IT, White KS. The cervical tube pedicle flap: uses in facial reconstruction. Br J Plast Surg. 1992;45(5):398-402. doi:10.1016/0007-1226(92)90014-O.
4. Hammoudeh Z, Wirtz J. Plastic surgery contributions to the world wars: A historical perspective. J Craniofac Surg. Published online 2023. doi:10.1097/SCS.0000000000002126.
5. Conley JJ. The evolution of head and neck reconstruction. Ann Otol Rhinol Laryngol. 1967;76(4):725-48. doi:10.1177/000348946707600410.
6. Weaver DF. Use of the tubed pedicle flap in head and neck surgery. Trans Am Laryngol Assoc. 1967;88:120-140.
7. Filatov VP. Plastic procedure using a round pedicle (title translated). Vestnik Oftalmologii. 1917;34:149–128. In: McDowell F, ed. The Source Book of Plastic Surgery. Baltimore: Williams & Wilkins Co; 1977:409-16.
8. Filatove VP. Plastic procedure using a round pedicle. Surg Clin North Am. 1959;39(2):277-87. doi:10.1016/s0039-6109(16)35731-0
9. Kumar P, Kumar M, Pandey A. Evolution of plastic surgery: Milestones and current trends. Med J Armed Forces India.2020;76(3):354-60. doi:10.1016/j.mjafi.2019.10.003.
10. Jing SS, Chakrabarty K. Standing on the shoulder of giants: Tubed pedicle radial forearm flap reconstruction for cutis aplasia. J Plast Reconstr Aesthet Surg. 2020;73(5):1000-4. doi:10.1016/j.bjps.2020.01.016.