Clinical efficacy of subsequent microvascular free flaps in head and neck reconstructive surgery

Microvascular free flap reconstruction is a standard technique in head and neck surgery with high success rates. Nevertheless, complications like early flap loss, locoregional recurrence of head and neck cancer and osteoradionecrosis may require further flap procedures. This study aims to assess outcomes and challenges associated with subsequent free flap procedures. In this retrospective cohort study, all patients who received subsequent free flaps between January 2013 and December 2022 were assessed and examined by explorative descriptive analysis. Furthermore, one exemplary case is presented. Overall, 69 patients with 150 free flaps were included, with up to 4 subsequently performed flaps. Reasons for subsequent flaps included early failure, local cancer recurrence, osteoradionecrosis and wound healing disorders. After early failures, subsequent flaps were successful in 97 % of this cohort. The more flaps were performed, the more likely the contralateral neck was used for vascular anastomosis and the more likely vein grafts were used. Subsequent free flap procedures are safe and viable options in head and neck reconstruction, even in cases of previous flap failure. Even if previous surgeries, already harvested flaps and radiation therapy might complicate the choice of reconstruction, this should not be a deterrent to achieve consistent rehabilitation of the patient.