Flow-Through Flaps as a Robust Method for Advanced Free Flap Reconstruction in the Head and Neck: A Multi-Institutional Experience.

Background: Flow-through flaps (FTFs) are an advanced technique in which a free flap is anastomosed to the pedicle of another free flap to reconstruct extensive head and neck defects when recipient vessels are scarce.

Methods: A multi-institutional cohort of FTFs used for head and neck reconstruction were reviewed. For comparison, FTF outcomes were compared to free flaps that required vein grafts (VG) to reach distant recipient vessels.

Results: A total of forty-two patients underwent surgery using a FTF configuration, including 32 simultaneous and 10 sequential FTFs. There were no instances of flap failure compared to a 7% flap failure rate in the VG group (n = 54). The overall postoperative complication rate was 28% compared to a 46% complication rate in the VG group (p = 0.093).

Conclusion: FTFs are a reliable option for reconstruction of extensive head and neck defects when recipient blood vessel availability is limited.