title: Role of multiple free flaps in head and neck reconstruction.
abstract: OBJECTIVE
  The benefit of using multiple simultaneous free flaps for postablative extensive composite head and neck reconstruction has gradually become increasingly accepted worldwide, with recent case series being reported from several continents. This review summarizes the cogent conclusions that can be drawn from this growing international experience.
  
  
  RESULTS
  Running themes include: firstly, that careful organization of the operation is critical to expediency to the extent that double and single free flap reconstructions are not greatly different in duration; secondly, that the functional results of double free flap reconstructions are generally better than single free flap reconstructions when the defect is appropriately extensive; and thirdly, that there remains a lack of consensus regarding which patients would and would not benefit from a double free flap approach from a survival perspective.
  
  
  CONCLUSIONS
  Local audit should guide local practice for when double free flap reconstructions are or are not appropriate, as survival data are greatly variable internationally because of the differences in treatment, margins status for resections and, amongst other factors, cause and aggression of tumors. This is especially the case for the most infiltrative malignancies that mandate extensive composite resections for which a double free flap procedure would likely provide the best long-term functional and aesthetic results.
authors.affiliation: Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Tao-Yuan Hsien, Taiwan.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wallace
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
mesh_terms: D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000379:methods*