Retrospective Clinical Analysis of Double Free-Flap Reconstruction of maxillofacial defect

Kiwoong Sung DDS, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
Jong Ho Lee , Seoul National University Dental Hospital, Seoul, South Korea
Myung-Jin Kim DDS, MSD, PhD, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
Myung Hoon , Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
SoungMin KIM , Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, South Korea
Objective: The purpose of this study was to analyze the result of double free-flap reconstruction cases retrospectively.

Patients and Methods: A total of 23 patients underwent double free-flap reconstruction between 1999 to 2014 at Seoul National University Dental Hospital(SNUDH). There were 13 men and 10 women. We examined Primary pathology, donor site of free flap, type of primary/secondary reconstruction, success rate, follow-up period, operate time.

Results:  Patient age ranged from 14 to 76 with mean age of 50 years, and mean post operative follow-up period was 56.1 months. Most common primary pathology was squamous cell carcinoma (56.5%), followed by adenoid cystic carcinoma (13.0%). 34.8% of the patients received radial forearm free flap for reconstruction while 26.1% and 23.9% of patients received latissimus dorsi free flap and fibular free flap, respectively. Remaining patients received serratus anterior free flap (8.7%) and rectus abdominis free flap (6.5%). The most frequently used combination of free flaps was that of radial forearm free flap and fibular free flap (21.7%), followed by combination of latissimus dorsi free flap and radial forearm free flap(17.4%) and combination of latissimus dorsi free flap and fibular free flap(17.4%). Among the 23 cases included in this study, 19 were primary reconstruction and 4 were secondary reconstruction. The mean operation time was 15 hours. Local complications included dehiscence (8 cases) and infection (1 case). Success rate of double free-flap was about 91%.

Conclusion:  Patients who had extensive defects after ablation have no optional solution. Double free-flaps reconstruction was a good alternative if single free-flaps are not applicable. Double free-flaps were an indication in case of composite tissue requirement.

Reference

1. Andrades P, Bohannon IA, Baranano CF, Wax MK, Rosenthal E. Indications and outcomes of double free flaps in head and neck reconstruction. Microsurgery 2009;29:171–177.    

2. Kalavrezos N, Bhandari R. Current trends and future perspectives in the surgical management of oral cancer. Oral Oncol 2010;46:429–432.

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