P121. THE USE OF FLOW-THROUGH FREE FLAPS FOR HEAD AND NECK RECONSTRUCTION

Abstract

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. 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.