In response to the article by Shaya et al. (Shyaka I, Su CL, Wei FC. Free Latissimus Dorsi Flaps in Head and Neck Reconstruction at a Modern High-Volume Microsurgery Center. Journal of Reconstructive Microsurgery , Published May 2025)on the use of free latissimus dorsi (LD) flaps in head and neck reconstruction, we provide additional insights based on our experience at a tertiary oncology center. While the authors emphasize the LD flap as a salvage option, we highlight its value as a primary reconstructive choice in patients with contraindications to anterolateral thigh (ALT) flaps, including those with prior thigh trauma or unfavorable body habitus. We also underscore the vascular advantages of the LD flap in comorbid patients, its utility in composite reconstructions when combined with parascapular elements, and its role in secondary surgery through pedicled approaches. Furthermore, we discuss its benefits in infection control, aesthetic contouring, and dead space management. Lastly, we advocate for the cephalic vein transposition as a reliable alternative venous outflow in vessel-depleted necks. Our experience supports expanding the LD flap's indications beyond salvage use, reinforcing its versatility in modern head and neck reconstructive surgery.

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针对Shaya等人（Shyaka I, Su CL, Wei FC. 自由背阔肌皮瓣在现代高容量显微外科中心头颈重建中的应用。《重建显微外科杂志》，2025年5月发表）关于自由背阔肌(LD)皮瓣用于头颈重建的文章，我们根据我们在一家三级肿瘤中心的经验提供了进一步的见解。虽然作者强调LD皮瓣作为补救选择的价值，但我们指出，在有禁忌使用前外侧股部(ALT)皮瓣的患者中，包括那些有既往大腿创伤或不良体型特征的患者，LD皮瓣在初次重建手术中的价值。我们还强调了LD皮瓣在合并症患者中的血管优势、与肩胛旁成分结合时进行复合重建的实用性以及通过带蒂方法进行二次手术的作用。此外，我们讨论了其在感染控制、美学轮廓塑造和死腔管理方面的益处。最后，我们提倡将头静脉移位作为颈部血管贫乏情况下的可靠静脉流出途径。我们的经验支持LD皮瓣应用范围扩展至补救性使用之外，进一步强化了其在现代头颈重建手术中的多功能性。

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