Use of Single Chimeric Free Flaps or Double Free Flaps for Complex Head and Neck Reconstruction

Abstract

Background Free flaps have become the preferred reconstructive approach to restore form and function for patients presenting with complex head and neck defects. For composite, complex defects for which a regular free flap might not meet all reconstructive demands, adequate coverage can be achieved with either a single chimeric free flap or a double free flap. Methods We performed a single-center retrospective chart review of patients who underwent either single chimeric free flap or double free flap reconstruction. Indications for reconstruction included defects resultant from head and neck tumor or osteoradionecrosis resections. We extracted the following variables: tumor location, defect, flap(s) performed, and postoperative complications. Unpaired t-tests were performed to evaluate for statistically significant differences in complications encountered between the single chimeric versus the double free flap patient groups. Results In our series of 44 patients, a total of 55 single chimeric and double free flaps were performed. We found no significant difference in overall complications (p = 0.41) or flap/skin paddle loss (p = 0.45) between the groups. There were three total flap losses; two patients underwent successful salvage procedures and one patient died. The anterolateral thigh (ALT) was the most common free flap (70%) used in our series, and 98% of our patients completed successful reconstruction. Conclusion As the initial reconstructive effort is critical for achieving favorable long-term outcomes in complex head and neck cases, effective and safe techniques should be employed to ensure optimal delivery of care. We believe that single chimeric and double free flap techniques should be appropriately utilized as part of the armamentarium of head and neck reconstructive microsurgeons.

Expanding the Armamentarium of Donor Sites in Microvascular Head and Neck Reconstruction

“…For instance, for an extensive through-and-through defect, if a flap with multiple components is needed, the ALT still represents the most reliable option. The ALT can be harvested, potentially with multiple skin paddles, and can easily also include muscle if necessary [ 54 ]. While a chimeric flap can also be designed for the PAP or the MSAP, this is often more challenging and limited due to the restrictions in mobility and length that can be obtained for each chimeric component.…”

Chimeric free fibula lateral supramalleolar flap in selected cases of mandible & maxilla defects- A pilot study

“…However, either a single chimeric free flap or double free flaps should be appropriately used as a part reconstructive surgeon's armamentarium. 14 The limitations of our study were limited sample size, lesser follow-up duration, and a retrospective study design.…”

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

“…Flaps can consist of one tissue type, such as cutaneous flaps, or, more frequently, several tissue types such as myocutaneous, fasciocutaneous, and bone flaps; the latter also often have a soft tissue part. Flaps vary depending on the complexity of the defect ( 19 ). The native tissue is not necessarily replaced by the same tissue, and the native mucosae is often substituted for skin from the donor site.…”