Double Free-Flap Reconstruction

Abstract

With proper patient selection and planning and the use of 2 surgical teams, the length of surgery and complication rates are not significantly increased in double free-flap reconstruction. Furthermore, by using 2 free flaps, the best osseous and soft-tissue elements may be independently selected, yielding appropriate tissue characteristics for ideal defect reconstruction.

Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. [20][21][22] Our finding of an elevated risk of major complications adds to this discussion and suggests that patients should be counseled on the increased risks associated with the performance of double free flaps performed on the SP.…”

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. 20–22…”

Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. [20][21][22] Our finding of an elevated risk of major complications adds to this discussion and suggests that patients should be counseled on the increased risks associated with the performance of double free flaps performed on the SP.…”

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. 20–22…”

Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

“…Twenty-three studies reported on operating room time, length of stay, and/or postoperative complications in a total of 476 patients (eFigure 4 in the Supplement). The mean (SD) weighted operating time (which includes the reconstruction) was 684 (110) minutes.…”

Double free flaps for complex oromandibular defects with two teams of head and neck reconstructive surgical oncologists

“…For reconstructing head and neck defects, no unified clinical practice guideline for the use of double free flaps exists. However, the following indications may warrant the consideration of a double free flap reconstruction: (i) huge complex defects involving oral mucosa, soft tissue, bone, and external skin that cannot be abundantly provided with one composite flap; (ii) large external coverage and oral lining defects that cannot adequately be resurfaced with one cutaneous or myocutaneous flap; or (3) difficulty insetting a single free flap because of huge and tri-dimensional nature of the defect [ 1 , 20 ]. It has been postulated (see Wei et al.…”

“…The use of two free flaps simultaneously has become our choice for reconstructing huge composite defects. Compared with a single free flap, the duration of surgery, complications and hospital stays were acceptable [ 20–22 ]. In fact, there were no significant differences in the duration of operation and complication rate in Guillemaud’s single-flap study [ 20 ].…”

Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. [20][21][22] Our finding of an elevated risk of major complications adds to this discussion and suggests that patients should be counseled on the increased risks associated with the performance of double free flaps performed on the SP.…”

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. 20–22…”

Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

“…Twenty-three studies reported on operating room time, length of stay, and/or postoperative complications in a total of 476 patients (eFigure 4 in the Supplement). The mean (SD) weighted operating time (which includes the reconstruction) was 684 (110) minutes.…”

Double free flaps for complex oromandibular defects with two teams of head and neck reconstructive surgical oncologists

“…For reconstructing head and neck defects, no unified clinical practice guideline for the use of double free flaps exists. However, the following indications may warrant the consideration of a double free flap reconstruction: (i) huge complex defects involving oral mucosa, soft tissue, bone, and external skin that cannot be abundantly provided with one composite flap; (ii) large external coverage and oral lining defects that cannot adequately be resurfaced with one cutaneous or myocutaneous flap; or (3) difficulty insetting a single free flap because of huge and tri-dimensional nature of the defect [ 1 , 20 ]. It has been postulated (see Wei et al.…”

“…The use of two free flaps simultaneously has become our choice for reconstructing huge composite defects. Compared with a single free flap, the duration of surgery, complications and hospital stays were acceptable [ 20–22 ]. In fact, there were no significant differences in the duration of operation and complication rate in Guillemaud’s single-flap study [ 20 ].…”

Outcomes Associated with Multiple Free Tissue Transfers Performed in a Single Day

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. [20][21][22] Our finding of an elevated risk of major complications adds to this discussion and suggests that patients should be counseled on the increased risks associated with the performance of double free flaps performed on the SP.…”

“…Current literature comparing single with double flap complication rates varies widely, with a prior study by Gabr et al suggesting a sixfold higher complication rate in double free flaps, but other studies by Guillemaud et al and Stalder et al suggesting no difference between the two techniques. 20–22…”

Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions

“…Twenty-three studies reported on operating room time, length of stay, and/or postoperative complications in a total of 476 patients (eFigure 4 in the Supplement). The mean (SD) weighted operating time (which includes the reconstruction) was 684 (110) minutes.…”

Double free flaps for complex oromandibular defects with two teams of head and neck reconstructive surgical oncologists

“…For reconstructing head and neck defects, no unified clinical practice guideline for the use of double free flaps exists. However, the following indications may warrant the consideration of a double free flap reconstruction: (i) huge complex defects involving oral mucosa, soft tissue, bone, and external skin that cannot be abundantly provided with one composite flap; (ii) large external coverage and oral lining defects that cannot adequately be resurfaced with one cutaneous or myocutaneous flap; or (3) difficulty insetting a single free flap because of huge and tri-dimensional nature of the defect [ 1 , 20 ]. It has been postulated (see Wei et al.…”

“…The use of two free flaps simultaneously has become our choice for reconstructing huge composite defects. Compared with a single free flap, the duration of surgery, complications and hospital stays were acceptable [ 20–22 ]. In fact, there were no significant differences in the duration of operation and complication rate in Guillemaud’s single-flap study [ 20 ].…”