Abstract
The simultaneous use of two different free flaps, harvested from distinct donor sites, has demonstrated a reasonable degree of safety and success rates in head and neck composite defects reconstruction. Unfortunately, their relatively low frequent use, together with the lack of proper statistics on their management strategies, make their indications weak of robust conclusions to better define their role in common practice. The aim of the present study was to review the literature of the last 15years regarding simultaneous free flap transposition, presenting advantages, disadvantages, and results of this technique, with the final purpose to propose an up-to-date panorama for the use of double free flap for complex head and neck defects reconstruction. Depending on which factors are present, surgeons may choose to select an approach that is theoretically safer, but yields less-than-ideal functional outcomes, such as local flap. Two free flaps may be necessary when the defect contains both a large, complex bony defect, large soft tissue needs, and proper surgical planning and meticulous monitoring continues to be the cornerstone of success.
Highlights
Resection of head and neck tumours can lead to complex and composite defects, which may encompass multiple functional regions (i.e.: face, oral cavity, or pharynx), by involving different tissues such as the mandibular or maxillary bone, soft tissues, facial skin or oral mucosa [1,2,3,4,5,6]
The aim of the present study was to review the literature of the last 15 years regarding simultaneous free flap transposition, presenting advantages, disadvantages, and results of this technique, with the final purpose to propose an up-todate panorama for the use of double free flap for complex head and neck defects reconstruction
The use of a single free flap could be insufficient to accomplish surgeons’ goals, often defect volume, dimension and its tissue variability, and drive the reconstructive option selection [1,2,3,4,5,6]; though, to date, free microvascular flaps represent the gold standard treatment for composite head and neck defects reconstruction, due to the fact that they allow surgeons to push the boundaries of safe surgical resection while ensuring good functional results [1,5]
Summary
Resection of head and neck tumours can lead to complex and composite defects, which may encompass multiple functional regions (i.e.: face, oral cavity, or pharynx), by involving different tissues such as the mandibular or maxillary bone, soft tissues, facial skin or oral mucosa [1,2,3,4,5,6]. The use of a single free flap could be insufficient to accomplish surgeons’ goals, often defect volume, dimension and its tissue variability, and drive the reconstructive option selection [1,2,3,4,5,6]; though, to date, free microvascular flaps represent the gold standard treatment for composite head and neck defects reconstruction, due to the fact that they allow surgeons to push the boundaries of safe surgical resection while ensuring good functional results [1,5] In this setting, even the simultaneous use of two different free flaps, harvested from distinct donor sites, has been well described by different authors and they have demonstrated a reasonable degree of safety and success rates [1,2,3,4,5,6]. It does represent a major procedure, and by itself may arguably have some disadvantages such as requiring prolonged operating time, increasing surgical stress in patients in poor general condition or with concomitant medical problems, and it might enclose technical difficulties as securing two adequate pairs of recipient vessels and performing two sets of anastomosis
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