title: Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects.
abstract: BACKGROUND
  Massive defects of the head and neck regions after resection of advanced carcinoma often require two flaps for optimal reconstruction. This study focuses on the selection of proper recipient vessels.
  
  
  METHODS
  A total of 262 free-flap transfers were performed in 130 patients using the two-flap approach (one patient received two flaps twice).
  
  
  RESULTS
  For microvascular anastomosis of inner flaps (intraoral lining-bone reconstruction flaps), the ipsilateral facial artery was used in 56 flaps (42.8 percent), the ipsilateral superior thyroid artery was used in 49 flaps (37.4 percent), and a branch of the internal jugular vein was used as recipient vein in 101 flaps (77.1 percent). For external flaps (soft-tissue-external skin reconstruction flaps), the ipsilateral superior thyroid artery was used in 59 flaps (50.4 percent) and the transverse cervical artery was used in 19 flaps (16.2 percent). In 14 patients the inner flaps provided distal run-off for external flap revascularization. Only seven flaps required vein grafts; they were all used for external face reconstruction (2.8 percent). There were six total (2.3 percent) and 12 partial (4.6 percent) flap failures.
  
  
  CONCLUSIONS
  Recipient vessel selection and preparation in primary head and neck cancer reconstruction requiring two simultaneous flaps should take into consideration (1) avoidance of unnecessary destruction during tumor ablations and preservation of as many neck vessels as possible, (2) length and diameter match between flap pedicles and recipient vessels to avoid vein grafts, and (3) possible need of another free-flap reconstruction for flap failure, complication, recurrence, or secondary primary cancers. The previously radiated or operated neck does not preclude the use of recipient vessels from that side. Distal run-off of the inner flap for external flap revascularization should be avoided if possible. Once those principles are observed, two-flap reconstruction for primary cancer presents no more difficulties than single-flap reconstruction.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Sukru
authors.initials: S
authors.lastname: Yazar
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
authors.forename: Wei-Chao
authors.initials: WC
authors.lastname: Huang
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D044964:Cervicoplasty / Q000379:methods; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013699:Temporal Arteries / Q000601:surgery