Long-Term Outcomes after Double Free Flap Reconstruction for Locally Advanced Head and Neck Cancer.

Area of Science:

• Microsurgery
• Head and Neck Oncology
• Reconstructive Surgery

Background:

• Extensive composite defects in head and neck cancer often require complex reconstruction.
• Simultaneous, multiple free flaps are a viable option, but surgeon concerns persist regarding outcomes and survival.

Purpose of the Study:

• To evaluate complications, long-term survival, and patient-reported outcomes after multiple free flap reconstruction for head and neck cancer.
• To address surgeon reluctance by providing evidence on the safety and efficacy of these procedures.

Main Methods:

• Retrospective review of patients undergoing multiple free flap reconstruction for head and neck cancer (1999-2014).
• Evaluation of patient charts for demographics, treatment, complications, and survival.
• Assessment of patient-reported outcomes using the Eat Assessment Tool (EAT-10) and Intelligibility Rating Scale (IRS) for surviving patients.

Main Results:

• 95% complete flap survival in 42 patients (84 flaps).
• 46.3% five-year patient survival; 19 patients alive at mean 55-month follow-up.
• Good functional outcomes: mean EAT-10 score 8.4 (swallowing), 90% moderate-to-good speech intelligibility (IRS).

Conclusions:

• Multiple, simultaneous free flaps are safe and effective for extensive head and neck cancer reconstruction.
• These challenging microvascular reconstructions yield acceptable long-term survival and functional results.
• The study supports the utility of these procedures in selected patients with advanced disease.