Technical Considerations in Patients Requiring a Second Microvascular Free Flap in the Head and Neck

Abstract

Second free flap reconstructions in the head and neck can be safely accomplished. We have found that the availability of recipient vessels is the most important consideration in these patients. The dissection of the contralateral side of the neck is often required, but the use of flaps with long pedicles obviates the need for vein interposition grafts. Compared with the success rate in this study, the relevant literature suggests that flap survival rates are lower when interposition grafts are used. Modifications in flap-harvesting techniques and inset geometry can also be used to facilitate insets in complicated surgical fields that have been reoperated on.

Multiple Free Flap Reconstructions of Head and Neck Defects Due to Oral Cancer

“…If these ipsilateral vessels were not available, the contralateral neck vessels were evaluated, and alternatives such as the contralateral facial vessels, or the superior thyroid vessels were used. 1 The facial vessels and the superior thyroid vessels in the contralateral side of the neck were the most used with no flap complications in our cases.…”

“…1 Thus, multiple free flap reconstructions in the head and neck present a distinct technical challenge. 2 Difficulties can occur because of prior surgical scarring, postsurgical alteration of anatomy, intraoral or extraoral soft-tissue defects, 3 and complications such as infection, draining fistulae, and poor vascularity of local tissue.…”

“…2 Difficulties can occur because of prior surgical scarring, postsurgical alteration of anatomy, intraoral or extraoral soft-tissue defects, 3 and complications such as infection, draining fistulae, and poor vascularity of local tissue. 1 Also, in multiple reconstructive cancer surgeries, limitation of selective recipient vessels by previous neck dissection or radiotherapy hampers successful reconstruction. 4 …”

“…However, the success rate of multiple flap reconstructions reportedly ranges from 28% to 95% 1,5–7 in the literature with conflicting suggestions. 8 Moreover, there have been few detailed studies on the complications associated with multiple free flap reconstructions in patients with a history of external radiation therapy to the head and neck.…”

“…1,9 The objective of this study was to reassess the relationship between previous treatments, anastomosed vessels, side of the neck where anastomosis was performed, and complications following multiple free flap reconstructions in the head and neck.…”