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2008 Annual Meeting Abstracts

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Reconstruction of Extensive Head and Neck Defects With Multiple Simultaneous Free Flaps
Matthew M. Hanasono, M.D., Y. Etan Weinstock, M.D., Peirong Yu, M.D..
The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.

Purpose: Extensive head and neck defects may not be amenable to reconstruction with a single flap. Our goal was to evaluate the feasibility and functional outcomes of reconstructive surgery involving multiple simultaneous free flaps.
Methods: A review of consecutive cases requiring multiple simultaneous free flaps for head and neck reconstruction between 2001 and 2007 at The University of Texas M. D. Anderson Cancer Center was performed.
Results: Seventy-nine free flaps were performed in 39 patients. Thirty-four patients (87%) underwent mandibular reconstruction for 14 (33%) bone and full-thickness cheek defects, 9 (23%) bone and hemiglossectomy defects, and 11 (31%) bone and subtotal/total glossectomy defects. Five patients (13%) had extensive palatomaxillary defects. Free flaps included: 35 fibula osseous/osteocutaneous, 28 anterolateral thigh, 10 radial forearm, 3 iliac crest osseous/osteocutaneous, 1 lateral arm, 1 superficial inferior epigastric artery, and 1 serratus anterior muscle with rib. The mean operation time, including the time for extirpative surgery, was 13.8 ± 2.9 hours. The mean intensive care unit stay was 4.3 ± 5.5 days and the mean hospital stay was 11.5 ± 5.0 days.
Two patients had laryngectomies and the remainder received tracheostomies. Of the tracheostomy group, 31 patients (89%) were successfully decannulated. In this same group, 28 patients (81%) demonstrated speech with greater than 80% of words intelligible as assessed by a speech pathologist. Twenty-three (79%) of 29 patients who were feeding tube-independent preoperatively received all of their nutrition orally postoperatively. Patients who were partially or totally feeding tube-dependent postoperatively underwent a mandibulectomy with either a hemiglossectomy (n=2) or near total/total glossectomy (n= 4). Of the patients who underwent a mandibulectomy with near total/total glossectomy and were able to tolerate a regular diet preoperatively, 55% maintained a regular diet postoperatively. There were 18 complications occurring in 13 patients (33%), including: 2 venous thromboses, 2 wound dehiscences, 1 neck hematoma, 1 neck seroma, 1 partial flap loss, 8 donor site complications, 1 pneumonia, and 1 respiratory arrest due to mucous plugging.
Conclusions: Multiple simultaneous free flaps can be performed safely in patients with acceptable recovery times and functional outcomes. In select cases, we advocate multiple free flap reconstruction to maximize function and quality of life.


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