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

Eric V Mastrolonardo; Sarah Sussman; Pablo Llerena; Dev R Amin; Kathryn Nunes; Kelly Bridgham; Emma De Ravin; Daniel J Campbell; Aarti Agarwal; Ramez Philips; Fahad Rind; Ryan Ivancic; Wesley McIlwain; Stephen Y Kang; Yadranko Ducic; Larissa Sweeny; Mauricio A Moreno; René P Meyers; Carissa M Thomas; Karthik Rajasekaran; Mark Wax; Joseph M Curry; Matthew M Hanasono

doi:10.1002/hed.28061

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

Head Neck. 2025 Jan 6. doi: 10.1002/hed.28061. Online ahead of print.

Authors

Eric V Mastrolonardo¹, Sarah Sussman², Pablo Llerena¹, Dev R Amin¹, Kathryn Nunes¹, Kelly Bridgham¹, Emma De Ravin¹, Daniel J Campbell¹, Aarti Agarwal¹, Ramez Philips³, Fahad Rind², Ryan Ivancic², Wesley McIlwain⁴, Stephen Y Kang², Yadranko Ducic⁴, Larissa Sweeny⁵, Mauricio A Moreno⁶, René P Meyers⁷, Carissa M Thomas⁸, Karthik Rajasekaran⁹, Mark Wax¹⁰, Joseph M Curry¹, Matthew M Hanasono¹¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
² Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
³ Department of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, Illinois, USA.
⁴ Head and Neck Cancer Center of Texas, Dallas, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
⁷ Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

PMID: 39760171
DOI: 10.1002/hed.28061

Abstract

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.

Keywords: flow‐through flap; free flap; free tissue transfer; head and neck; reconstruction.