The use of free chimeric flaps in head and neck reconstruction: technical pearls and clinical applications

Abstract

Aim: Head and neck region reconstructions are often delicate procedures that require different solutions at different layers. The use of chimeric flaps offers the interesting characteristic of combining different tissues, which is extremely valuable in this setting. In the present work, we share our experience with different types of conventional flaps, such as the radial flap, the medial sural artery perforator flap, and the fibula osteocutaneous flap.

Methods: Over the last year, a series of five patients received advanced head and neck defects reconstruction employing chimeric flaps. The patients included two females and three males, with the mean age of 68-year-old. The defect was in four cases due to radical tumor resection in the oromandibular region. The fifth case was an osteoradionecrosis which needed a complete resection of the affected soft and bony tissue.

Results: All five patients were successfully treated. Two of them received a chimeric free flap composed of multiple skin islands while the other three also comprised bone tissue transfer for mandible reconstruction. The mean follow-up period was ten months (range 3-8 months), and during this period neither postoperative complications nor signs of disease relapse were noted.

Conclusion: The results obtained resorting to the chimeric fashion of various free flaps suggests that they are an excellent solution from both the functional and aesthetic point of view. Specific technical modifications are proposed according to the case requirements.

Keywords

Head and neck reconstruction / chimeric flap / radial flap / medial sural artery perforator / fibula flap / multiple skin paddle / mandible reconstruction

References

[1] Thompson-Harvey A,Hansen AR.Rising incidence of late-stage head and neck cancer in the United States..Cancer2020;126:1090-101

[2] Haughey BH,Kluwe L.Free flap reconstruction of the head and neck: analysis of 241 cases..Otolaryngol Head Neck Surg2001;125:10-7

[3] Yazar S,Chen HC.Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects..Plast Reconstr Surg2005;115:1553-61

[4] Hallock GG.Further clarification of the nomenclature for compound flaps..Plast Reconstr Surg2006;117:151e-60e

[5] Ettyreddy AR,Zenga J,Pipkorn P.Complications and outcomes of chimeric free flaps: a systematic review..Otolaryngol Head Neck Surg2019;161:568-75

[6] Haughey BH,Kluwe L.Free flap reconstruction of the head and neck: analysis of 241 cases..Otolaryngol Head Neck Surg2001;125:110-7

[7] Hurvitz KA,Evans GRD.Current options in head and neck reconstruction..Plast Reconstr Surg2006;118:122e-33e

[8] Koshima I,Hosoda M,Orita Y.Free combined composite flaps using the lateral circumflex femoral system for repair of massive defects of the head and neck regions: an introduction to the chimeric flap principle..Plast Reconstr Surg1993;92:411-20

[9] Barton FE Jr,Byrd HS.Head and neck reconstruction with the latissimus dorsi myocutaneous flap: anatomic observations and report of 60 cases..Plast Reconstr Surg1983;71:199-204

[10] Bartlett SP,Yaremchuk MJ.The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle..Plast Reconstr Surg1981;67:631-6

[11] Hallock GG.Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle..Ann Plast Surg1991;27:126-31

[12] Song Y,Song Y.The free thigh flap: a new free flap concept based on the septocutaneous artery..Br J Plast Surg1984;37:149-59

[13] Park CW.The expanding role of the anterolateral thigh free flap in head and neck reconstruction..Curr Opin Otolaryngol Head Neck Surg2011;19:263-8

[14] Soutar D,Tanner N.The radial forearm flap: a versatile method for intra-oral reconstruction..Br J Plast Surg1983;36:1-8

[15] Soutar DS.The radial forearm flap in intraoral reconstruction: the experience of 60 consecutive cases..Plast Reconstr Surg1986;78:1-8

[16] Yang G,Gao Y.Classic reprint Forearm free skin flap transplantation: a report of 56 cases. 1981..Br J Plast Surg1997;50:162-5

[17] Richardson D,Vaughan ED.Radial forearm flap donor-site complications and morbidity: a prospective study..Plast Reconstr Surg1997;99:109-15

[18] Cavadas PC,Gutierrez-de la Cámara A,Soler-Nomdedeu S.The medial sural artery perforator free flap..Plast Reconstr Surg2001;108:1609-15discussion 1616-7

[19] Kim HH,Seul JH.New design and identification of the medial sural perforator flap: an anatomical study and its clinical applications..Plast Reconstr Surg2006;117:1609-18

[20] Weitz J,Kesting MR.Development of a novel resection and cutting guide for mandibular reconstruction using free fibula flap..J Craniomaxillofac Surg2018;46:1975-8

[21] Levis C,Archibald S.Through and through defects of the lower face..Clin Plast Surg2005;32:327-37v-vi

[22] Serletti JM,Tavin E.Simultaneous transfer of free fibula and radial forearm flaps for complex oromandibular reconstruction..J Reconstr Microsurg1998;14:297-303

[23] Wei FC,Chen HC,Huang WC.Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects..Plast Reconstr Surg2002;109:45-52

[24] Jeng SF,Wei FC,Chien CY.Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters..Plast Reconstr Surg2005;115:1830-6