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Pedicled flaps have a long history in reconstructive armamentarium, first description dating back in 600 BC (Sushruta Samhita). The face was, in fact, the first anatomical territory in which these flaps were applied. Their continuous study, development, refinement and description, through the great work of Gillies, Filatov, McGregor and many others, made them a great tool in the hands of reconstructive maxillofacial surgeons.
Development and refinement of free flaps had thrown a shadow on these pedicled flaps, in case of intra and extraoral reconstructions, although their usefulness cannot be challenged. Nowadays, pedicled have been replaced, in great percent, by free flaps for medium/large-sized defects.
Despite, there are still plentiful situations in which pedicled flaps prove their advantages: simpler and shorter surgery, proper availability for the morphology of the defect, lesser morbidity, availability in the hands of maxillofacial surgeon etc. They also represent the plan B reconstruction, in case free-flaps plan A fails. The presentation is aimed to review, through clinical cases, the advantages, and limitations of nowadays pedicled flaps in the modern era of free flaps.