The Use Of Flow-through Free Flaps For Head And Neck Reconstruction
Mark A. Maier, BS1, Patrick A. Palines, MD2, Richard F. Guidry, MD2, Mark W. Stalder, MD2.
1School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA, 2Division of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
PURPOSE: Reconstructive obstacles in composite head and neck defects are compounded in re-operated, irradiated, and vessel-depleted surgical fields. In cases that require multiple free flaps, recipient vessel availability and inset logistics become challenging. Strategic flow-through flap configurations mitigate these issues by providing a built-in option for inflow to a second flap. This approach permits use of one native recipient vessel, increased reach of the inflow vessels, and greater flexibility to configure soft tissue and bony flap inset.
METHODS: 38 head and neck free flap cases were reviewed from an academic hospital in New Orleans, Louisiana, taking place between March 2019 - April 2021. Nine cases utilized flow-through free flaps for reconstruction.
RESULTS: Seven oncologic and two traumatic patients (N=9) received multiple flaps arranged in flow-through configuration (ALT: 78%; Fibula: 78%; DCIA: 22%; Peroneal Artery Perforator: 11%; MSAP: 11%) for reconstruction (Table 1). Configurations involved ALT -> Fibula (56%), ALT -> DCIA (22%), Fibula -> Peroneal artery perforator (11%), Fibula -> MSAP (11%). Recipient vessels included facial (78%), transverse cervical (11%), and occipital (11%) arteries. No flap failures occurred, though complications included infection (22%), dehiscence (44%), hematoma (22%), thrombosis (11%), and others (33%).
CONCLUSIONS: In head and neck reconstruction, the use of the flow-through principle enables uninterrupted vascular flow for two distinct free flaps in single stage reconstruction for patients with vessel-depleted, irradiated, and re-operated fields.
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