Reconstruction of Extensive Head and Neck Defects with Multiple Simultaneous Free Flaps

Background: Extensive head and neck defects may not be amenable to reconstruction with a single flap. The authors' evaluated the feasibility and functional outcomes of reconstructive surgery involving multiple simultaneous free flaps. Methods: Cases involving multiple simultaneous free flaps for head and neck reconstruction between 2001 and 2007 at the University of Texas M. D. Anderson Cancer Center were reviewed. Results: Seventy-nine free flaps were performed in 39 patients. Thirty-four patients (87 percent) underwent mandibular reconstruction for 14 bone and full-thickness cheek defects (36 percent), nine bone and hemiglossectomy defects (23 percent), and 11 bone and near total or total glossectomy defects (28 percent). Five patients (13 percent) had extensive palatomaxillary defects. The mean operation time, including the time for extirpative surgery, was 13.8 hours. The mean intensive care unit stay was 4.3 days, and the mean hospital stay was 11.5 days. Two patients had laryngectomies and the remainder received tracheostomies. Of the tracheostomy group, 33 patients (89 percent) were decannulated. In this same group, 30 patients (81 percent) demonstrated speech with greater than 80 percent of words intelligible. Twenty-three of 29 patients (79 percent) who were feeding tube-independent preoperatively received all of their nutrition orally postoperatively. Patients who were partially or totally feeding tube-dependent postoperatively underwent either a hemiglossectomy or near total or total glossectomy, with mandibulectomy. Conclusions: Multiple simultaneous free flaps can be performed safely in patients, with acceptable recovery times and functional outcomes. In select cases, the authors advocate multiple free flap reconstruction to maximize quality of life even in patients with advanced cancers. (Plast. Reconstr. Surg. 122: 1739, 2008.)