This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Oncology  • Head & Neck Cancer  • Cancer Reconstruction of Head & Neck  • Neoplasms of Head & Neck  • Surgery  • Surgical Oncology  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Indications, Challenges, and Prospective Functional Outcomes

Jennifer P. Guillemaud, MD; Hadi Seikaly, MD, FRCSC; David W. J. Cote, MD, MPH; Brittany R. Barber, BSc; Jana M. Rieger, PhD; Johan Wolfaardt, BDS, MDent, PhD; Peggy Nesbitt, MA, CCC-SLP; Jeffrey R. Harris, MD, FRCSC

Arch Otolaryngol Head Neck Surg. 2009;135(4):406-410.

Objective  To investigate the increasing use of double free flaps in the reconstruction of large head and neck defects.

Design  A 5-year retrospective medical record review in a large tertiary care head and neck oncology program. Prospectively collected functional data were also analyzed.

Setting  Academic research.

Patients  A consecutive series of 35 patients (24 men and 11 women; mean age, 57.7 years).

Main Outcome Measures  The use of double free flaps in the reconstruction of large head and neck defects and prospective functional outcomes.

Results  The most common indication for surgery (n = 25 [71.4%]) was squamous cell carcinoma. The most common double free-flap combination (n = 22 [62.9%]) included an osteocutaneous fibular free flap with a fasciocutaneous radial forearm free flap. Objective evaluation by naive listeners demonstrated a mean single-word intelligibility score of 66.2% and a mean sentence intelligibility score of 84.8% in this group of patients. Modified barium swallow study results revealed no evidence of laryngeal penetration for swallowing liquid consistencies in 21 patients (60.0%), pudding consistencies in 30 patients (85.7%), and cookie consistencies in 32 patients (91.4%).

Conclusions  With proper patient selection and planning and the use of 2 surgical teams, the length of surgery and complication rates are not significantly increased in double free-flap reconstruction. Furthermore, by using 2 free flaps, the best osseous and soft-tissue elements may be independently selected, yielding appropriate tissue characteristics for ideal defect reconstruction.

Author Affiliations: Division of Otolaryngology–Head and Neck Surgery, University of Alberta Hospital (Drs Guillemaud, Seikaly, Cote, and Harris and Mss Barber and Nesbitt), and Institute for Reconstructive Sciences in Medicine (Drs Rieger and Wolfaardt), Edmonton, Alberta, Canada.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?