Double Free Flaps in Head and Neck Reconstruction

Selection of recipient vessels in microsurgical free tissue reconstruction of head and neck defects

“…Bone or soft tissue can be selected to permit reconstruction with functional and esthetic results superior to those of many of the local and pedicled flap options. 2 However, for free tissue transfer to be successful, proper selection of recipient vessels is as essential as many other factors that affect the final result. [3][4][5][6][7][8] The head and neck region has an extensive bilateral vascular network, which when selected using the appropriate strategy is readily accessible 8,9 for single free flap transfer in primary carcinoma patients, for subsequent free tissue transfer in recurrent patients or patients with complications, and even for simultaneous double free flap transfers.…”

Double free flap reconstruction of through-and-through oromandibulofacial defects

“…Vein grafts were required in only 2.8% cases, reflecting the careful planning and availability of pedicle length with the fibula and ALT flaps. Sequential linking of free flaps should be approached with caution, as this resulted in a 29% partial necrosis rate of the distal free flap in this series [8]. In other series of sequentially linked flap, a higher rate of total necrosis (22-30%) involving both flaps has been reported [24,33].…”

“…Although other groups have suggested that it may be a more suitable flap in limited throughand-through lateral defects, it is insufficient for massive anterolateral defects [23]. Scapula and iliac osteocutaneous flaps have had a more limited role in our series of double free flap reconstructions being used in 6% [8], whilst the fibula OSC flap remains our preferred osteocutaneous flap.…”

“…In our series of 262 double free flaps, we described four main types of recipient vessels [8]: firstly, two separate pairs of ipsilateral neck or temporal vessels (62% cases); secondly, two separate pairs of neck or temporal vessels-one ipsilateral and one contralateral (27% cases); thirdly, one pair of ipsilateral neck or temporal vessels with sequential linking of two free flaps (8%); and fourthly, one contralateral pair of neck or temporal vessels with sequential linking of two free flaps (3%). For the fibula OSC flap, the most frequently used arterial recipients were the ipisilateral facial artery (43%) and superior thyroid (37%), with the ipsilateral branch of internal jugular vein used for venous drainage (77%).…”

“…The long vascular pedicles of the ALT and fibula also result in vein grafts being rarely required. This review article details our own approach and experience in the management of through-and-through oromandibulofacial defects with double free flaps, with a single institute experience of over 130 cases [8]. We also consider the current status of double free flaps in terms of complication profile, functional and aesthetic outcomes in a review of the current literature.…”