Flow-through sequentially linked free flaps in head and neck reconstruction

Reconstructing extensive composite oromandibular defects is a difficult challenge. Many donor sites have been used including rib, second metatarsal, radius, scapula, iliac crest and fibula. Each of these flaps has advantages and disadvantages with regard to the donor defect, length of bone available, bone stock and reliability of the associated soft tissue. Additionally, a significant limitation in some patients is that the bone cannot be repositioned three-dimensionally with respect to the overlying skin island. The complex three-dimensional nature of composite resections may challenge the ability of any single osteocutaneous flap to adequately reconstruct all aspects of the resultant defect. To overcome this problem, the authors present a retrospective analysis of their experience with the flow-through sequentially linked free flaps concept for reconstruction of complex defects of head and neck in nine selected cases.