Background: Treatment decisions can be challenging in patients undergoing multiple oropharyngeal microsurgical reconstructions at different periods by various causes. We retrospectively reviewed patients with at least three consecutive free flap reconstructions to determine the optimal strategy for selecting recipient vessels.
Methods: Thirty-six patients (33 men and 3 women) who underwent at least 3 microsurgical reconstructions with a total of 51 free flap transfers for head and neck defects were included in this report. The most common reason for multiple microsurgical reconstructions was recurrent disease, followed by second primary tumor and mandibular osteoradionecrosis. For reconstructions, recipient vessel candidates on the same side of the head and neck were prioritized; if ipsilateral neck vessels were unavailable, contralateral recipient vessels in the neck, which might necessitate vein grafts, were used.
Results: The most common reconstructions were anterolateral thigh flaps (19 cases), followed by radial forearm (11 cases) and medial sural artery perforator (11 cases) flaps. Ipsilateral recipient vessels that were not subjected to radiation could be reused. The most commonly used contralateral recipient vessels were the superior thyroid artery, facial artery, and external jugular vein. All vessel anastomoses were performed using the end-to-end method. Postoperative complications occurred at the sites of 26 free flap reconstructions. The overall flap reconstruction success rate in patients with at least three surgeries was 90.2%. The median follow-up duration was 25.8 months (range, 4–66 months). During follow-up, 10 patients died because of cancer progression; the remaining 26 patients survived until the end of follow-up.
Conclusions: In patients undergoing multiple free flap reconstructions, recipient vessels on the ipsilateral side that have not been subjected to radiation should be selected first. Recipient vessels contralateral to the reconstruction side can then be selected; however, they may require vein grafts. Finally, distant healthy recipient vessels can be selected through vein grafting.