Multiple simultaneous free flaps for head and neck reconstruction: A multi-institutional cohort

Objectives: To describe the experience of two tertiary academic centers with multiple, simultaneous free flaps for complex head and neck defect reconstruction. Methods: Patients undergoing multiple, simultaneous free flaps from 2017 to 2022 were retrospectively reviewed. Results: Seventy-one patients (64.8% male, median age 61 years) were identified and underwent 143 free flaps. The leading surgical indication was squamous cell carcinoma (n = 48, 67.6%). Defect sites included oral cavity, maxilla, pharynx, parotid, skull base, and scalp. The most common free flap combinations were fibula (FFF) with anterolateral thigh flap (n = 33, 46.5%), radial forearm (RFFF) with scapula (n = 11, 15.5%), and RFFF with FFF (n = 10, 14.1%). Median operative time was 12 h. Median length of hospitalization was 10 days. At last follow-up (median 6 months), 141 flaps (98.6%) survived without partial nor complete flap failure. Conclusion: Multiple, simultaneous free flaps are a rare, yet reliable option for head and neck reconstruction in select patients with defects involving several tissue types, multiple functional areas, or large volumes.