Abstract
Background The use of simultaneous, multiple free flaps has become a reliable reconstructive
option in patients with extensive composite defects after resection of locally advanced
head and neck cancer. However, some reluctance remains among reconstructive surgeons
with concerns regarding flap outcomes and limited patient survival. Therefore, we
evaluated complications, long-term patient survival, and patient-reported outcomes
following these extensive head and neck reconstructions.
Methods All consecutive patients treated with multiple free flaps for reconstruction of extensive
composite defects after resection of locally advanced head and neck cancer between
1999 and 2014 were retrospectively reviewed. Patient charts were evaluated for demographics,
treatment details, complications, and patient survival. In addition, all patients
alive at the start of the study were asked to complete the 10-item Eat Assessment
Tool (EAT-10) and the Intelligibility Rating Scale (IRS).
Results Eighty-four simultaneous, multiple free flaps were performed in 42 patients. The
predominant free flap combination consisted of a fibula with either an anterolateral
thigh (n = 22) or a radial forearm flap (n = 14). Complete flap survival was 95%. Nineteen patients were still alive with a
mean follow-up of 55 months. Five-year patient survival was 46.3%. Mean EAT-10 score
was 8.4 (range: 0–29), with only one patient reporting problematic swallowing. Ninety
percent of the patients had moderate to good speech intelligibility with the IRS.
Conclusion Multiple, simultaneous free flaps can be performed safely, leading to acceptable
long-term patient survival and patient-reported functional outcomes. Our study demonstrates
that it is worthwhile to perform these challenging microvascular reconstructions in
patients with locally advanced head and neck cancer.
Keywords
head and neck - patient-reported outcomes - long-term outcomes
