Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer

Extensive composite defects of the lower jaw are defined as those that invo lve skin, mandible, oral mucosa, and soft tissues. The enormous size and mu ltilayered nature of these defects challenge most of the current reconstruc tive techniques. For reconstruction of extensive composite mandibular defec ts in 36 advanced oral cancer patients, two free flaps were used simultaneo usly in a complementary fashion. The aim was to provide bone reconstruction and adequate soft-tissue coverage in an optimal form. Primary reconstructi on was carried out in 34 of 36 cases. The fibula osteoseptocutaneous-radial forearm fasciocutaneous flap combination was most commonly used (n = 20), followed by the fibula osteoseptocutaneous-rectus abdominis myocutaneous fl ap (n = 11). The other combinations included the fibula osteoseptocutaneous -tensor fasciae latae, the fibula osteoseptocutaneous-rectus femoris, the i liac crest-radial forearm, and the iliac crest-tenser fasciae latae flaps. In 11 cases, the second free flaps were attached to the distal runoff of th e first free flaps because of unavailability of recipient vessels. The mean operation time was 12 hours 10 minutes. The complete flap survival rate wa s 93 percent (67 of 72 flaps) with 2.8 percent total (2 of 72) and 4.2 perc ent partial (3 of 72) flap failures. Median follow-up time was 14 months, a nd 44 percent of the patients were alive at the time of evaluation, survivi ng an average of 36 months. The average survival time for those who died wa s 11.1 months. The authors believe that in selected cases the double free-f lap procedure for one-stage reconstruction of massive mandibular defects is justified because it is safe and effective and improves the quality of lif e and the number of days spent outside of the hospital for these patients.