The second-time flap from the previously used anterior thigh donor site for head and neck microsurgical reconstruction

BACKGROUND: Multiple free tissue transfer from the same donor site is not well described for microsurgical head and neck reconstruction. METHODS: Between (8/2011 and 11/2012), 103 patients received 103 free ALT flaps for head and neck reconstruction; flaps were called first-time ALT flaps. Intra-operative findings were used to assess the presence of a favorable anatomy for a future second flap from the same donor site. And, between 9/2009 and 12/2013, second-time flaps from previously used anterior thighs were attempted either freely or guided by the intra-operative data from the previous surgery. RESULTS: A favorable anatomy for a future second-time flap was noted in (n: 96/103). Future second-time flaps were ALT, AMT, and TFL flaps (n: 32, n: 91, n: 96, respectively). The second-time flap was attempted (n: 11) and was successful (n: 8, 72.7%). Harvested second-time flaps were (5 ALT, 2 AMT, 1TFL). All flaps survived. The donor site was closed primarily (n: 6) and skin grafted (n: 2). CONCLUSION: Thorough exploration of the anatomy of the anterior thigh during the first-time ALT flap surgery with detailed documentation in addition to meticulous surgery are essential for success. The proposed concept limits morbidity to one site, and serves as an alternative donor site or a life-boat.