Multiple Sequential Free Flap Reconstructions of the Head and Neck: A Single-Center Experience. Issue 5 (November 2021)

• Record Type: Journal Article
• Authors: Moratin, Julius; Horn, Dominik; Heinemann, Maleen; Metzger, Karl; Mrosek, Jan; Ristow, Oliver; Engel, Michael; Freudlsperger, Christian; Freier, Kolja; Hoffmann, Jürgen
• Is Part Of: Plastic and reconstructive surgery. Volume 148:Issue 5(2021)
• Publication Date: 2021-11
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000008432
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Free flap reconstruction is the standard of care in extensive defects of the head and neck area, and although most patients may be treated sufficiently with one flap, recurrence of a malignant tumor or failure of a previous reconstruction may make the use of a second (or more) flap necessary. The aim of this study was to evaluate the indications and success rates of multiple consecutive reconstructive procedures in a large cohort of patients. Methods: Nine hundred ninety-six free flap reconstructions were retrospectively analyzed and cases of sequential reconstructions in the same patient were identified. Indications, success rates, perioperative procedures, and frequently used flaps were evaluated. Results: Two hundred twenty cases of sequential microvascular reconstructions were identified, ranging from two to six flaps per patient. The overall flap success rate was 89.1 percent. A history of diabetes was identified as a risk factor for flap failure ( p = 0.029). There was no association of flap loss with the number of reconstructive procedures per patient. Conclusions: The use of several free flaps in the same patient is a feasible option for patients suffering from recurrent tumors or to improve quality of life by a secondary reconstruction. A salvage free flap transfer to replace a lost transplant exhibits good success rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.