Double free-flap reconstruction: indications, challenges, and prospective functional outcomes.

OBJECTIVE

To investigate the increasing use of double free flaps in the reconstruction of large head and neck defects.

DESIGN

A 5-year retrospective medical record review in a large tertiary care head and neck oncology program. Prospectively collected functional data were also analyzed.

SETTING

Academic research.

PATIENTS

A consecutive series of 35 patients (24 men and 11 women; mean age, 57.7 years).

MAIN OUTCOME MEASURES

The use of double free flaps in the reconstruction of large head and neck defects and prospective functional outcomes.

RESULTS

The most common indication for surgery (n = 25 [71.4%]) was squamous cell carcinoma. The most common double free-flap combination (n = 22 [62.9%]) included an osteocutaneous fibular free flap with a fasciocutaneous radial forearm free flap. Objective evaluation by naive listeners demonstrated a mean single-word intelligibility score of 66.2% and a mean sentence intelligibility score of 84.8% in this group of patients. Modified barium swallow study results revealed no evidence of laryngeal penetration for swallowing liquid consistencies in 21 patients (60.0%), pudding consistencies in 30 patients (85.7%), and cookie consistencies in 32 patients (91.4%).

CONCLUSIONS

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.