title: Success of multiple, sequential, free tissue transfers to the head and neck.
abstract: BACKGROUND
  Free tissue transfer has become the primary reconstructive modality for significant ablative defects in the head and neck. The overall success rate is high, approaching 95% in most centers. The success rate of multiple sequential free flaps has been thought to be lower, based on the absence of optimal vessel availability and the presence of significant scar tissue in the previously operated patient. We evaluated a series of patients who underwent multiple free flaps at different time points to determine the overall success rate and to identify pitfalls encountered in this population.
  
  
  METHODS
  Retrospective review, tertiary care medical center.
  
  
  RESULTS
  From 1995 to 2002, 377 free flaps were performed by our reconstructive service. Of this group, 36 underwent multiple free flaps at different time points. Thirty-two had two flaps, and four had three flaps. Reasons for performing sequential free flap procedures were as follows: recurrent disease/new primary (18), need for further augmentation (10), failed previous flap (6), delayed mandibular reconstruction after plate fracture (2), mandibular osteoradionecrosis (3), and delayed pharyngoesophageal stenosis (1). The overall failure rate on the second and third flap was 2 of 32 and 0 of 4, respectively, with an overall success rate of 94%.
  
  
  CONCLUSIONS
  Multiple, sequential, free tissue transfer for reconstruction of head and neck defects is a safe and reliable procedure with success rates equal to that in patients undergoing initial free flap reconstruction. Careful preoperative planning can result in optimal outcomes even in this difficult patient population.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Varvares
authors.forename: Derrick
authors.initials: D
authors.lastname: Lin
authors.forename: Tessa
authors.initials: T
authors.lastname: Hadlock
authors.forename: Babak
authors.initials: B
authors.lastname: Azzizadeh
authors.forename: Richard
authors.initials: R
authors.lastname: Gliklich
authors.forename: Mark
authors.initials: M
authors.lastname: Rounds
authors.forename: James
authors.initials: J
authors.lastname: Rocco
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Deschler
authors.forename: Richard
authors.initials: R
authors.lastname: Fabian
authors.forename: Mack L
authors.initials: ML
authors.lastname: Cheney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013524:Surgical Flaps