Reconstruction of Advance Head and Neck Cancer Patients After Tumor Ablation With Simultaneous Multiple Free Flaps

Abstract

Simultaneous multiple free flaps have become a useful option in head and neck reconstructions. We performed a 10-year retrospective study between 2001 and 2010. There were 58 men and 1 woman. The overall mortality rate was 51.7%. The longest surviving patient is 9 years and 4 months, whereas the shortest surviving patient was 72 days. The mean survival period was 47.1 (6.8) months. Age (P = 0.755) and tumor size (P = 0.115) did not play a major role, but surgical margin, lymph node, and tumor recurrence were significant in patient survival with a P value of 0.026, 0.01, and 0.026, respectively. If wide excision with a margin that can be free of tumor can be performed, lymph nodes are not involved, and this is a primary tumor, then time and effort should be spent in a successful simultaneous multiple free flap reconstruction.

Complications of double free flap and free flap combined with locoregional flap in head and neck reconstruction: A systematic review

“…The challenge of more extensive dissections is magnified when the patient population undergoes preoperative radiation (48.6%), making it more difficult to secure a second set of vessels. Often times, this requires exploring the contralateral neck for vessels or resorting to using 1 of the free flaps as a flow‐through flap . Many studies acknowledged that this is not preferable because occlusion of 1 flap may lead to the demise of both flaps .…”

“…This has proven to be a reliable and safe surgical method with good functional outcomes for the patient . However, the double free flap provides unique reconstruction capabilities that have been shown to be effective in addressing some of the most challenging aspects of head and neck reconstruction while carrying admirable success rates of 93%‐100% …”

Role of multiple free flaps in head and neck reconstruction

“…Also in 2012, Chien et al [10] from Dalin, Taiwan, published a case series of 59 consecutive patients who underwent multiple simultaneous free flaps for head and neck reconstruction. Three of 121 free flaps failed and were salvaged with two free forearm and one pedicled pectoralis major flap.…”

A modified free chimeric osteocutaneous fibular flap design for head and neck reconstruction: Experience on a series of 10 cases

“…However, limitations of the soft tissue in the traditional fibular osteocutaneous flap designs had been reported in head and neck reconstructions. This design is inadequate when a large skin paddle is required to simultaneously reconstruct the intraoral and cheek skin defects . We proposed a modified free chimeric fibular flap design, which was a combination of a traditional fibular osteocutaneous flap and a peroneal artery perforator flap, to provide larger skin paddle for soft tissue reconstruction.…”

“…This design is inadequate when a large skin paddle is required to simultaneously reconstruct the intraoral and cheek skin defects. [4][5][6][7][8] We proposed a modified free chimeric fibular flap design, 9 which was a combination of a traditional fibular osteocutaneous flap and a peroneal artery perforator flap, to provide larger skin paddle for soft tissue reconstruction. An alternative to this design was a combination of a fibular osseous flap and a peroneal artery perforator flap, which allowed less restriction in the flap inset compared to the traditional fibular osteocutaneous flap that contained the intermuscular septum between skin paddle and the fibular bone.…”