With the recent improvement of free tissue transfer for oral and maxillofacial reconstruction, more patients are requiring second resections and reconstructions. The aim of this study was to evaluate the applications, complications and success rate of second free flaps for oral and maxillofacial reconstruction.
Thirty-six second free flaps for oral and maxillofacial reconstruction were performed in 32 patients from 1995 to April 2010, at Hokuto Hospital and Hokkaido University Hospital. Four patients who underwent a third free flap reconstruction were also included in this study. The reason for reconstruction using a second free flap was secondary jaw reconstruction in 21 flaps, recurrence or metachronous carcinoma in 6 flaps, osteoradionecrosis of the mandible in 7 flaps, and first free flap failure in 2 flaps. Thirty of the 36 second free flaps were bone reconstruction using scapula (16 cases) and fibula (14 cases). The overall complication rate among the second free flaps was 27.8% (10 of 36 flaps). The complications were: delayed wound healing at the flap harvest site (3 cases), cervical wound infection or dehiscence (4 cases), partial flap necrosis (1 case), and total flap necrosis (2 cases). Thus, the success rate for the second free flap was 94.4%. Although many second free flaps were used for secondary jaw reconstruction, the success rate was relatively high with a low overall complication rate. This study demonstrates that second free flaps are a promising and safe resource for oral and maxillofacial reconstruction, and that the appropriate choice of flap and availability of recipient vessels are of vital importance to avoid complications.