(0685) Multiple Simultaneous Free Flaps for Reconstruction of Head and Neck Defects

Introduction: The resection of head and neck tumors often results in complex defects that involve multiple tissue types and functional regions. While judicious selection of a single flap type routinely accomplishes a surgeon’s goals of filling defect volume and re-establishing functional and aesthetic outcomes, in rare cases a single flap is insufficient and multiple simultaneous free flaps may be used. This technique has demonstrated reasonable efficacy and safety in the otolaryngologic literature; however, it does pose theoretical disadvantages including increased operating times and potential doubling of anastomosis sites and donor sites which ostensibly increases complication risks.

Methods: We retrospectively reviewed all multiple, simultaneous free flap reconstructive operations in the department of otolaryngology/HNS over a twenty-year period from October 2000 until December of 2021. Case parameters including operative duration, postoperative LOS, rate of return to OR, likelihood of discharge to skilled nursing facility, postoperative complication rate, and overall survival were then compared to that of single flap reconstructions completed during the same time.

Results: Over the study period, 10 patients underwent multiple, simultaneous free flap reconstruction, 4 with combined parascapular and latissimus dorsi reconstruction, and 6 with combined scapular and latissimus dorsi reconstruction. A total of 8 patients (80%) involved osteocutaneous reconstruction while 2 (20%) involved only myocutanenous or fasciocutaneous transposition. There was no statistically significant difference in operative time, overall complication rate, anastomotic failure rate, or need to return to OR within 30 days. Compared to solitary flaps, multiple flap cases did show a statistically significant increase in postoperative admission duration (p < 0.01), likelihood of discharge to a SNF (p-0.03) and decrease in overall survival (p-0.02).

Conclusions: Multiple, simultaneous free flap reconstruction is a rare but reliable method for addressing complex defects of the head and neck.