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  • Title: Double free-flap reconstruction: indications, challenges, and prospective functional outcomes.
    Author: Guillemaud JP, Seikaly H, Cote DW, Barber BR, Rieger JM, Wolfaardt J, Nesbitt P, Harris JR.
    Journal: Arch Otolaryngol Head Neck Surg; 2009 Apr; 135(4):406-10. PubMed ID: 19380366.
    Abstract:
    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.
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