Intraoral reconstruction using a second free flap for recurrent or metachronous carcinoma

A retrospective review of clinical records at Canniesburn Hospital has identified 6 patients in whom intraoral squamous carcinomas were excised and reconstruction performed by free tissue transfer on two separate occasions. The interval between procedures ranged from 8 months to 8 years. One dorsalis pedis flap was used and the other tissue transfers were radial forearm free flaps, two of which were osteocutaneous. One flap completely failed and the rest survived. There was no evidence of greater risk in carrying out a second microsurgical intraoral reconstruction in this series. 4 out of 6 patients remain alive following their second procedure, one after 9 years. The results suggest that in selected cases it may be worthwhile to carry out a major intraoral reconstruction on more than one occasion.