Complications and Outcomes of Chimeric Free Flaps: A Systematic Review

Abstract

Objective Ablations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making. Data Sources The librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997). Review Methods Candidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates. Results A total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively. Conclusion Chimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.

January’s 2020 Full Issue PDF

“…According to Buntic and Bunke the chimeric flap is a flap which is composed of more than one flap each on its own pedicle but with both on a common source pedicle. 15 Despite the myriad of combinations 15 of the chimeric flaps which can be created there are some most popular examples 16 in the reconstruction of composite head and neck defects 6 .…”

“…Ettyreddy et al 16 analyzed 521 chimeric flaps in the reconstruction of head and neck defects. The leading flap became a chimeric anterolateral thigh flap (N = 213 flaps, i.e.…”

Health-Related Quality of Life in Oral Cancer Patients: Scoping Review and Critical Appraisal of Investigated Determinants

“…Furthermore, the related complications may heavily impair the functional outcome, requiring a much longer recovery time, long-term rehabilitation programs, or even secondary surgery. Moreover, according to the chosen procedure, free flaps may lead to various donor site morbidity [84,85]. All these aspects should be considered for their potential effects on HRQOL.…”

The use of free chimeric flaps in head and neck reconstruction: technical pearls and clinical applications

“…Alternative solutions are single free flap combined with a locoregional flap or multiple free flaps. Compared to them, chimeric flaps offer significant advantages in terms of versatility, maintaining a similar complications rate [5] . Resorting to this pattern allows combining more skin paddles and different tissues according to the need while still using a single vascular supply.…”