ABSTRACT
Over the past decade, free-tissue transfer has greatly improved the quality of oncology-related
head and neck reconstruction. As this technique has developed, second free flaps have
been performed for aesthetic improvement of the reconstructed site. This study evaluated
the indications for and the success of second free flaps. Medical files for patients
who underwent second free flaps for head and neck reconstruction at the University
of Texas M.D. Anderson Cancer Center, from May 1, 1988 to November 30, 1996, were
reviewed. The flaps were classified as being either immediate (done within 72 hr)
or delayed (done within 2 years) reconstructions. Indications, risk factors, recipient
vessels, outcome, and complications were analyzed.
Of the 28 patients included in this study, 12 had immediate (nine as salvage after
primary free flap failure, and three for reconstruction of a soft-tissue defect),
and 16 had delayed second free flaps (two for reconstruction of a defect resulting
from excision of recurrent tumors, and 14 for aesthetic improvement). Reconstruction
sites included the oral cavity in 18 patients; the midface in six; the skull base
in two; and the scalp in two. The success rate for the second free flaps was 96 percent.
Five patients had significant wound complications. In a substantial number of cases,
identical recipient vessels were used for both the first and second free flaps.
The authors conclude that second free flaps can play an important role in salvaging
or improving head and neck reconstruction in selected patients. In many cases, the
same recipient vessels can be used for both the first and second flaps.
