title: Double free-flap reconstruction: indications, challenges, and prospective functional outcomes.
abstract: OBJECTIVE
  To investigate the increasing use of double free flaps in the reconstruction of large head and neck defects.
  
  
  METHODS
  A 5-year retrospective medical record review in a large tertiary care head and neck oncology program. Prospectively collected functional data were also analyzed.
  
  
  METHODS
  Academic research.
  
  
  METHODS
  A consecutive series of 35 patients (24 men and 11 women; mean age, 57.7 years).
  
  
  METHODS
  The use of double free flaps in the reconstruction of large head and neck defects and prospective functional outcomes.
  
  
  RESULTS
  The most common indication for surgery (n = 25 [71.4%]) was squamous cell carcinoma. The most common double free-flap combination (n = 22 [62.9%]) included an osteocutaneous fibular free flap with a fasciocutaneous radial forearm free flap. Objective evaluation by naive listeners demonstrated a mean single-word intelligibility score of 66.2% and a mean sentence intelligibility score of 84.8% in this group of patients. Modified barium swallow study results revealed no evidence of laryngeal penetration for swallowing liquid consistencies in 21 patients (60.0%), pudding consistencies in 30 patients (85.7%), and cookie consistencies in 32 patients (91.4%).
  
  
  CONCLUSIONS
  With proper patient selection and planning and the use of 2 surgical teams, the length of surgery and complication rates are not significantly increased in double free-flap reconstruction. Furthermore, by using 2 free flaps, the best osseous and soft-tissue elements may be independently selected, yielding appropriate tissue characteristics for ideal defect reconstruction.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, University of Alberta Hospital, Room 1E4.29 Walter MacKenzie Health Science Centre, 8440-112 St, Edmonton, AB T6G 2R7, Canada.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Guillemaud
authors.forename: Hadi
authors.initials: H
authors.lastname: Seikaly
authors.forename: David W J
authors.initials: DW
authors.lastname: Cote
authors.forename: Brittany R
authors.initials: BR
authors.lastname: Barber
authors.forename: Jana M
authors.initials: JM
authors.lastname: Rieger
authors.forename: Johan
authors.initials: J
authors.lastname: Wolfaardt
authors.forename: Peggy
authors.initials: P
authors.lastname: Nesbitt
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D001466:Barium Sulfate; D003528:Carcinoma, Adenoid Cystic / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003287:Contrast Media; D003679:Deglutition; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D013065:Speech Intelligibility; D013524:Surgical Flaps
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate