The second-time flap from the previously used anterior thigh donor site for head and neck microsurgical reconstruction.
BACKGROUND
Multiple free tissue transfer from the same donor site is not well described for microsurgical head and neck reconstruction.


METHODS
Between (8/2011 and 11/2012), 103 patients received 103 free ALT flaps for head and neck reconstruction; flaps were called first-time ALT flaps. Intra-operative findings were used to assess the presence of a favorable anatomy for a future second flap from the same donor site. And, between 9/2009 and 12/2013, second-time flaps from previously used anterior thighs were attempted either freely or guided by the intra-operative data from the previous surgery.


RESULTS
A favorable anatomy for a future second-time flap was noted in (n: 96/103). Future second-time flaps were ALT, AMT, and TFL flaps (n: 32, n: 91, n: 96, respectively). The second-time flap was attempted (n: 11) and was successful (n: 8, 72.7%). Harvested second-time flaps were (5 ALT, 2 AMT, 1TFL). All flaps survived. The donor site was closed primarily (n: 6) and skin grafted (n: 2).


CONCLUSIONS
Thorough exploration of the anatomy of the anterior thigh during the first-time ALT flap surgery with detailed documentation in addition to meticulous surgery are essential for success. The proposed concept limits morbidity to one site, and serves as an alternative donor site or a life-boat.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Nidal Farhan
NF
Al Deek
Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Chun-Ta
CT
Liao
Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Shiang-Fu
SF
Huang
Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Chung-Jan
CJ
Kan
Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Kai-Ping
KP
Chang
Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Ku-Hao
KH
Fang
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan.
Chung-Kan
CK
Tsao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058752:Free Tissue Flaps / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013848:Thigh; D060053:Transplant Donor Site
anterolateral thigh flap; head and neck reconstruction; multiple free flaps; second-time flap