Multiple simultaneous free flaps for head and neck reconstruction: A multi-institutional cohort

Tharakan, Theresa; Marfowaa, Gifty; Akakpo, Kenneth; Jackson, Ryan; Zenga, Joseph; Puram, Sidharth V.; Pipkorn, Patrik

doi:10.1016/j.oraloncology.2022.106269

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…Two patients presented with intermuscular vein thrombosis in the lower limbs, which were successfully managed with oral medication, preventing the progression to potential organ embolisms such as cardiac, pulmonary, or cerebral embolism. Additionally, two cases demonstrated a pulmonary infection, which was effectively controlled with antibiotic therapy (Tharakan et al, 2023). reported postoperative complications in multi-flap surgeries to range from 26% to 50%, aligning with our findings.…”

Section: Case Presentationsupporting

confidence: 90%

“…Consequently, the combination of multiple flaps has emerged as an innovative therapeutic approach (Lee et al, 2010;Weitz et al, 2015;Hsieh and Bewley, 2019;Silva et al, 2019;Moratin et al, 2021;Raghuram et al, 2021;Santilli et al, 2021;Tharakan et al, 2023). The ALT can furnish sufficient tissue volume and can be fashioned into a chimeric flap with minimal impact on the donor site, rendering it an Frontiers in Bioengineering and Biotechnology frontiersin.org optimal choice for repair and reconstruction of large soft tissue defects in the oromandibular region (Thomas et al, 2020).…”

Section: Case Presentationmentioning

confidence: 99%

“…Despite their advantages, multi-flap approaches for the reconstruction of composite oromandibular defects continue to be challenging and are a subject of ongoing debate. A few reports are available on the functional and aesthetic outcome of double free flap reconstructions in these defects (Lee et al, 2010;Tharakan et al, 2023). The objective of this study is to evaluate the effect of the combination of VSP/3D printing-assisted FOSCF with ALT in composite tissue defects reconstruction which could not be solved by one single flap.…”

Section: Introductionmentioning

confidence: 99%

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Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series

Xu,

Li,

Xiao

et al. 2023

Front. Bioeng. Biotechnol.

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Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7 cm2, 96 mm, and 68.9 cm2. The mean surgical procedures took 712.5 min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3 months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2 months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.

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Section: Case Presentationsupporting

confidence: 90%

Section: Case Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series

Xu,

Li,

Xiao

et al. 2023

Front. Bioeng. Biotechnol.

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“…Although some cases may be feasible with a single free flap, using two free flaps does not cause an increase in flaprelated complications and may reduce donor site morbidity by reducing individual flap sizes. [18][19][20] However, this is not thoroughly described when the flaps are arranged in a flowthrough fashion. Compared with a single flap, use of two flaps facilitates reconstruction of large defects that include intraoral mucosa, facial bone, and extraoral skin through ease of positioning and inset.…”

Section: Discussionmentioning

confidence: 99%

Use of Flow-through Free Flaps in Head and Neck Reconstruction

Maier,

Palines,

Guidry

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Reconstructive obstacles in composite head and neck defects are compounded in reoperated, traumatized, irradiated, and vessel-depleted surgical fields. In cases that require multiple free flaps, recipient vessel accessibility and inset logistics become challenging. Strategic flow-through flap configurations mitigate these issues by supplying arterial inflow and venous outflow to a second flap in a contiguous fashion. This approach (1) permits the use of a singular native recipient vessel, (2) increases the reach of the vascular pedicle, avoiding the need for arteriovenous grafting, and (3) allows for a greater three-dimensional flexibility in configuring soft tissue and bony flap inset. Methods: To demonstrate this technique, we conducted a retrospective review of all head and neck reconstruction patients presenting to us from March 2019 to April 2021. Results: We present seven oncological and two traumatic patients (N = 9) who received flow-through free flaps for head and neck reconstruction. The most common flap used as the flow-through flap was the anterolateral thigh flap (N = 7), followed by the fibula flap (N = 2). Mean follow-up time was 507 days. No flap failures occurred. Conclusion: In head and neck reconstruction, the use of the flow-through principle enables uninterrupted vascular flow for two distinct free flaps in single-stage reconstruction for patients with vessel-depleted, irradiated, and/or reoperated fields. We demonstrate that flow-through flaps in the head and neck may be used successfully for a variety of cases and flaps.

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Chimeric Versus Multiple Simultaneous Free Flaps for Head and Neck Reconstruction

Wang,

Tharakan,

Jackson

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo describe our experience with chimeric flaps and to assess the surgical outcomes and postoperative complications associated with chimeric flaps compared to multiple flaps.Study Design/MethodsPatients undergoing chimeric and multiple simultaneous free tissue transfer between June 2016 and October 2023 were retrospectively reviewed. The primary outcome of interest was the complication rate. Major complications required takeback to the operating room, hospital readmission, or transfer to the intensive care unit. Minor complications were managed conservatively. Secondary outcomes included operative time, length of hospitalization, and flap survival.SettingAcademic tertiary care center.ResultsOur analysis included 113 patients (chimeric n = 38, multiple n = 75). We found no significant difference in operative times or minor complications. Chimeric flaps were associated with a shorter length of hospitalization. The major complication rate was higher for chimeric flaps (42.1% vs 22.7%, P = .03), but each cohort only had 1 instance of total flap loss.ConclusionThe complexity of large head and neck defects poses a reconstructive challenge for microvascular surgeons. Our findings suggest that chimeric and multiple flaps both produce acceptable complication rates when used appropriately. Differences in complication rates may reflect differences in utilization. The chimeric flap remains a valuable option for those with prior radiation or radical resection, but it remains unclear the degree to which they lessen the inherent risk of postoperative complications within this population. Each technique must be weighed in context of the patient's reconstructive profile and the institution's surgical capabilities to optimize long‐term outcomes.

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Multiple simultaneous free flaps for head and neck reconstruction: A multi-institutional cohort

Cited by 6 publications

References 16 publications

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series

Use of Flow-through Free Flaps in Head and Neck Reconstruction

Chimeric Versus Multiple Simultaneous Free Flaps for Head and Neck Reconstruction

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