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Updated: Jan 14, 2026
Coronoid-Temporalis Pedicled Flap for Orbital Floor Defect Reconstruction
Published on: December 5, 2025
Orochi Flaps in Head and Neck Reconstruction
Rami Elmorsi1, Edward I Chang1, Peirong Yu1
1From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center.
Background:
Multiple simultaneous free flap reconstructions for extensive head and neck defects in vessel-depleted necks are extremely challenging. The Orochi flap, in which 1 or more secondary free flaps are anastomosed to the main pedicle of a primary free flap, resulting in a fabricated chimeric flap, may be a useful option when recipient vessels are scarce.
Methods:
Orochi free flap reconstructions for head and neck defects performed from 2005 through 2024 were reviewed. Postoperative outcomes were compared with those of traditional free flaps and vein-grafted free flaps using multivariable regression and propensity score matching.
Results:
Seventy-two Orochi flaps were compared with 385 traditional flaps and 47 vein-grafted flaps. The flap loss rate was 0% for primary Orochi flaps and 4% for secondary Orochi flaps. Only vein-grafted flaps (odds ratio, 68.7 [95% CI, 2.6 to 1788.6]) and history of free flaps (odds ratio, 44.2 [95% CI, 2.2 to 879.4]) were found to be independent predictors of total flap loss on multiple regression analysis. In propensity score-matched analysis, Orochi flaps were associated with shorter median hospital stays (8 versus 10 days [ P < 0.05]) and vein-grafted flaps were associated with higher rates of overall complications (21% versus 8.3% [ P = 0.037]) and total flap loss (7.1% versus 0% [ P = 0.035]) compared with traditional flaps.
Conclusion:
Orochi flaps are a reliable option for head and neck reconstruction requiring multiple simultaneous free flaps in patients with vessel-depleted necks and may offer advantages over vein grafting to reach recipient vessels at distant sites.
