title: Free tissue transfer as a vascular source for the vessel-depleted neck.
abstract: Reconstructing head and neck defects postoncologic resection can be challenging. This problem is further amplified when tackling the vessel-depleted or hostile neck. Free flaps still provide the gold standard of reconstructing such defects. However, with increasing reconstructions, recipient vessel options rapidly diminish. This article provides a technique and strategy in managing such difficult cases using previous free flap pedicles. It also highlights the importance of flap selection in paving the way for future successful reconstructions.
  
  
  
  We present a fifth sequential free flap reconstruction postoncologic buccal resection and mention the key steps taken to ensure the safe and successful reuse of previous free flap pedicles.
  
  
  
  Intraoperative and postoperative photographs are clearly presented with a particular focus on the management of the recipient pedicle.
  
  
  
  Adequate planning and strategic selection of free flaps with long pedicles can provide the necessary vascular sources needed for future successful free flap head and neck reconstructions. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2515-E2518, 2016.
authors.affiliation: Department of Plastic Surgery, Chang Gung Memorial Hospital, Taiwan, Peoples Republic of China. nightman251@hotmail.com.
authors.forename: Chung-Kan
authors.initials: CK
authors.lastname: Tsao
authors.affiliation: Center for Vascularized Composite Allotransplantation, Department of Plastic Surgery, Chang Gung Memorial Hospital, Department of Reconstructive Microsurgery, College of Medicine, Chang Gung University, Taiwan.
authors.forename: Charles Yuen Yung
authors.initials: CY
authors.lastname: Loh
authors.affiliation: Department of Plastic Surgery, Chang Gung Memorial Hospital, Taiwan, Peoples Republic of China.
authors.forename: Joaquim Megias
authors.initials: JM
authors.lastname: Barrera
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009333:Neck / Q000098:blood supply* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: flap inset; hostile neck; microsurgery; reusing pedicles; sequential flap; tunneling; vessel-depleted neck