title: Second free flaps in head and neck reconstruction.
abstract: BACKGROUND
  Ablative surgery for head and neck cancer often results in defects that require free flap reconstruction. Improved survival after refined oncologic and adjuvant techniques has led to an increase in the number of patients undergoing a second free flap reconstruction. The objective of this study was to assess outcomes following a second free flap in head and neck reconstruction.
  
  
  METHODS
  Following ablative defects in the head and neck, 1475 patients underwent reconstructive surgery over a period of 17 years. A second free flap for reconstruction was performed on 123 of these patients. In Group 1, 93 patients had a reconstruction for either tumour recurrence, second primary tumour or reconstructive complications (fractured plate, osteoradionecrosis, orocutaneous fistula). In Group 2, 30 patients had a second free flap following primary free flap reconstructive failure.
  
  
  RESULTS
  Flap success for Group 1 patients was 86/90 (96%) compared to group 2 patients, 22/30 (73%) (p < 0.05). In Group 1, partial necrosis occurred in four patients whereas in Group 2, there was only one partial necrosis (NS; p > 0.05).
  
  
  CONCLUSIONS
  A second free flap may be required for reconstruction of head and neck defects following complications of the initial reconstruction, presence of a second primary or tumour recurrence. Success rates for second free flap reconstructions were significantly lower in those patients with initial free flap failure.
authors.affiliation: Division of Plastic & Reconstructive Surgery, University Health Network, 200 Elizabeth Street, 8N-865, Toronto, ON M5G 2C4, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Ross
authors.forename: Tuija M
authors.initials: TM
authors.lastname: Yla-Kotola
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.forename: Ralph
authors.initials: R
authors.lastname: Gilbert
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Gullane
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult