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Role of multiple free flaps in head and neck reconstruction

Wallace, Christopher G.; Tsao, Chung-Kan; Wei, Fu-Chan

Current Opinion in Otolaryngology & Head and Neck Surgery: April 2014 - Volume 22 - Issue 2 - p 140–146
doi: 10.1097/MOO.0000000000000039
HEAD AND NECK ONCOLOGY: Edited by Piero Nicolai and Cesare Piazza

Purpose of review The benefit of using multiple simultaneous free flaps for postablative extensive composite head and neck reconstruction has gradually become increasingly accepted worldwide, with recent case series being reported from several continents. This review summarizes the cogent conclusions that can be drawn from this growing international experience.

Recent findings Running themes include: firstly, that careful organization of the operation is critical to expediency to the extent that double and single free flap reconstructions are not greatly different in duration; secondly, that the functional results of double free flap reconstructions are generally better than single free flap reconstructions when the defect is appropriately extensive; and thirdly, that there remains a lack of consensus regarding which patients would and would not benefit from a double free flap approach from a survival perspective.

Summary Local audit should guide local practice for when double free flap reconstructions are or are not appropriate, as survival data are greatly variable internationally because of the differences in treatment, margins status for resections and, amongst other factors, cause and aggression of tumors. This is especially the case for the most infiltrative malignancies that mandate extensive composite resections for which a double free flap procedure would likely provide the best long-term functional and aesthetic results.

Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Tao-Yuan Hsien, Taiwan

Correspondence to Professor Fu-Chan Wei, MD, FACS, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kuei-Shan Hsiang, Tao-Yuan Hsien (333), Taiwan. Tel: +886 3 3960067; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins