A Ten-Year Experience of Multiple Flaps in Head and Neck Surgery: How Successful Are They?

ABSTRACT

Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution’s 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. Five hundred eighty-two flaps in 534 patients were identified with full details regarding ablation and reconstruction with a minimum of 6-month follow-up. Of these 584 flaps, 506 were for primary reconstruction, 50 for secondary reconstruction, 12 for tertiary reconstruction, and 8 patients underwent two flaps simultaneously for extensive defects. Overall flap success was 550/584 (94%). For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction (p < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.

KEYWORDS

Free flap reconstruction - multiple flaps - head and neck

REFERENCES

• 1 Pickford M A, Soutar D S. Intraoral reconstruction using a second free flap for recurrent or metachronous carcinoma.  Br J Plast Surg. 1995;  48 559-563
• 2 Amin A A, Baldwin B J, Gurlek A et al.. Second free flaps in head and neck reconstruction.  J Reconstr Microsurg. 1998;  14 365-368
• 3 Wells M D, Luce E A, Edwards A L et al.. Sequentially linked free flaps in head and neck reconstruction.  Clin Plast Surg. 1994;  21 59-67
• 4 Wei F C, Demirkan F, Chen H C et al.. Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.  Plast Reconstr Surg. 1999;  103 1158-1166
• 5 Wei F C, Yazar S, Lin C H et al.. Double free flaps in head and neck reconstruction.  Clin Plast Surg. 2005;  32 303-308
• 6 Jeng S F, Kuo Y R, Wei F C et al.. Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters.  Plast Reconstr Surg. 2005;  115 1830-1836
• 7 Yazar S, Wei F C, Chen H C et al.. Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects.  Plast Reconstr Surg. 2005;  115 1553-1561
• 8 Wei F C, Celik N, Chen H C et al.. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects.  Plast Reconstr Surg. 2002;  109 45-52
• 9 Demirkan F, Wei F C, Chen H C et al.. Oromandibular reconstruction using a third free flap in sequence in recurrent carcinoma.  Br J Plast Surg. 1999;  52 429-433
• 10 Wei F C, Demirkan F, Chen H C et al.. Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.  Plast Reconstr Surg. 1999;  103 1158-1166
• 11 Demirkan F, Wei F C, Chen H C et al.. Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient.  Plast Reconstr Surg. 1999;  103 829-838
• 12 Wei F C, Demirkan F, Chen H C, Chen I H. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer.  Plast Reconstr Surg. 1999;  103 39-47
• 13 Schusterman M A, Kroll S S, Weber R S et al.. Intraoral soft tissue reconstruction after cancer ablation: a comparison of the pectoralis major flap and the free radial forearm flap.  Am J Surg. 1991;  162 397-399
• 14 Talesnik A, Markowitz B, Calcaterra T et al.. Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects.  Plast Reconstr Surg. 1996;  97 1167-1178
• 15 Tsue T T, Desyatnikova S S, Deleyiannis F WB et al.. Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx.  Arch Otolaryngol Head Neck Surg. 1997;  123 731-737
• 16 Horng S Y, Chen M T. Reversed cephalic vein: a lifeboat in head and neck free-flap reconstruction.  Plast Reconstr Surg. 1993;  92 752-753
• 17 Nakayama Y, Soeda S, Iino T. A radial forearm flap based on an extended dissection of the cephalic vein. The longest venous pedicle? Case report.  Br J Plast Surg. 1986;  39 454-457
• 18 David D J, Tan E, Katsaros J, Sheen R. Mandibular reconstruction with vascularized iliac crest: a 10-year experience.  Plast Reconstr Surg. 1988;  82 792-803
• 19 Jewer D D, Boyd J B, Manktelow R T et al.. Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and new method of classification.  Plast Reconstr Surg. 1989;  84 391-403
• 20 Boyd J B, Gullane P J, Rotstein L E et al.. Classification of mandibular defects.  Plast Reconstr Surg. 1993;  92 1266-1275