Related Experiment Video
Updated: Jun 23, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Double free-flap reconstruction: indications, challenges, and prospective functional outcomes
Jennifer P Guillemaud1, Hadi Seikaly, David W J Cote
1Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, Room 1E4.29 Walter MacKenzie Health Science Centre, 8440-112 St, Edmonton, AB T6G 2R7, Canada.
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.