Outcomes after Complex Head and Neck Reconstruction Using Chimeric Flap Vs One Component Flaps: Matched Cohort Study

BACKGROUND - Composite head and neck defects may require more tissue offered by one component autologous free flaps and may need chimeric flaps for coverage. The aim of the study is to determine if chimeric free flap reconstruction of composite head and neck defects is associated with higher complications rates compared with one component free flaps.

METHODS - We performed retrospective cohort study and included all chimeric free flap reconstruction in our institution from 2005-2013. We identified a matched cohort of patients who underwent standard free flap reconstruction. We identified preoperative variables using univariate analysis to allow matching and performed multivariate regression analysis to identify factors predictor complications.

RESULTS - Of 467 patient who underwent head and neck free flap reconstruction, forty-two patients had chimeric free flap reconstruction. Matching algorithm yielded similar cohort of patients who underwent standard reconstruction. The most common indication requiring chimeric flap was squamous cell cancer resection involving the mandible. We found the most common types of chimeric flap used were fibula flap and the anterior lateral thigh flap, using the facial artery and branch of internal jugular as recipient vessels. There were no flap loss and all patients had a stable airway and were receiving enteral feeds upon discharge. Surgical complication rate was 32% with wound infection being the most common. Medical complication rate was 16% and there were no perioperative mortality. Surgical and medical complication rates, costs and length of procedure were similar for patient cohort who underwent standard reconstruction. Multivariate regression analysis showed the use of chimeric flaps was not associated with increased complication rates.

CONCLUSIONS - For composite head and neck defects, chimeric flaps, with its dual tissue paddle and single microvascular anastomosis, provide reliable and versatile reconstruction without additional morbidity compared to standard flaps with excellent outcomes.