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Published on: December 5, 2025
Alternative Soft Tissue Free Flaps in Multi-Flap Head and Neck Reconstruction: A Propensity Score-Matched Analysis
Rami Elmorsi1, Edward I Chang1, Erica Xue1
1Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Background:
Multi-flap reconstruction is often required for extensive head and neck defects, especially in recurrent disease, prior reconstruction, or vessel-depleted necks. While traditional donor sites remain foundational, the reliability of alternative soft tissue free flaps is less defined.
Methods:
This retrospective cohort study compared traditional and alternative soft tissue free flaps in multi-flap head and neck reconstruction. Outcomes were analyzed in unmatched and propensity score-matched cohorts. Primary endpoints included overall recipient site complications, flap loss, thrombosis, reoperation, and length of stay.
Results:
The unmatched cohort included 171 patients and 347 flaps: 297 traditional (86%) and 50 alternative (14%). After matching, outcomes were comparable between groups. No statistically significant differences were seen in recipient site complications, reoperation, thrombosis, flap loss, or hospital stay.
Conclusions:
Alternative soft tissue free flaps appear safe and reliable when traditional workhorse flaps are unavailable.
