Free tissue transfer as a vascular source for the vessel-depleted neck

Background: Reconstructing head and neck defects postoncologic resection can be challenging. This problem is further amplified when tackling the vessel-depleted or hostile neck. Free flaps still provide the gold standard of reconstructing such defects. However, with increasing reconstructions, recipient vessel options rapidly diminish. This article provides a technique and strategy in managing such difficult cases using previous free flap pedicles. It also highlights the importance of flap selection in paving the way for future successful reconstructions. Methods: We present a fifth sequential free flap reconstruction postoncologic buccal resection and mention the key steps taken to ensure the safe and successful reuse of previous free flap pedicles. Results: Intraoperative and postoperative photographs are clearly presented with a particular focus on the management of the recipient pedicle. Conclusion: Adequate planning and strategic selection of free flaps with long pedicles can provide the necessary vascular sources needed for future successful free flap head and neck reconstructions.