Talks
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Otolaryngology (OHNS)
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Surgery
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Otolaryngology (OHNS)
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Oral Presentation
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Patient Care
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Research/Clinical
Abstract
Background: Double-free flap reconstruction has emerged as a viable option for addressing more complicated defects after oncologic resection. We aim to report the feasibility of this approach at a single-institutional safety net hospital.
Methods: A retrospective chart review was performed between November 2020 and October 2023 for adult patients who underwent multiple, simultaneous free tissue transfers for head and neck defects following tumor resection. This study occurs at Ben Taub Hospital, a safety net hospital in Houston, Texas. Data collected included demographics, risk factors, oncologic and operative details, complications, and functional and disease outcomes. Socioeconomic status was assessed through the median household income (MHI) and area deprivation index (ADI). An ADI decile of 1 signifies the least disadvantaged populations, while 10 (for state) or 100 (national) represents the most disadvantaged.
Results: Between November 2020 and October 2023, 14 patients required double-free flap reconstruction. The mean (SD) follow-up time was 6.4 (4.4) months. A majority of our patients were minorities: 9 (64.3%) Hispanic, 2 (14.3%) black, 2 (14.3%) white, and 1 (8.3%) Asian. Additionally, our patients were highly socioeconomically disadvantaged. The MHI for our patient population was $52,307.00, and the median ADI was 7.5 (state decile) and 80.5 (national percentile). Thirteen (93%) patients were diagnosed with oral or oropharyngeal squamous cell carcinoma (OCSCC/OPSCC), and 1 (7%) was diagnosed with osteosarcoma of the maxilla. Thirteen (93%) patients were stage T4, 10 (71.4%) had nodal disease, and 3 (21.4%) presented with distant metastatic disease. Nine (64.3%) patients’ flaps consisted of the anterolateral thigh (ALT) and fibula, 3 (21.4%) had a double ALT combination, and 2 (14.3%) had a fibula and radial forearm free flap (RFFF). The mean (SD) length of surgery was 14 hours 54 minutes (1:35), and the mean (SD) length of stay was 19.3 (14.3) days. There were 2 partial flap losses, 0 total flap losses, 3 fistulas, 3 hematomas, 8 dehiscences, and 5 infections. Five (35.7%) patients required an unplanned return to the OR. The mean (SD) time to initiate radiotherapy postoperatively was 44.1 (6.8) days. Regarding functional outcomes, 8 (57.1%) returned to a partial or entirely oral diet, and 6 (42.9%) were either mostly or fully intelligible. Of the 11 patients that underwent tracheostomy, 8 (80.0%) were decannulated after a mean (SD) of 59.1 (75.5) days. Only 1 (7.1%) patient died within 90 days of surgery. Nine (64.3 %) patients were still alive, and 6 (43.3%) had persistent or recurrent disease at their latest follow-up. The mean (SD) time to recurrence was 6.6 (3.2) months.
Conclusion: This study demonstrates that double flap reconstruction is a viable option for reconstructing complex head and neck defects in disadvantaged patients with locally advanced malignancies. Further, it facilitates postoperative radiotherapy and provides an opportunity for functional recovery.
IRB Letter
Recommended Citation
Alsabawi, Yossef; Gaddis, John M.; Haskins, Angela D.; Shum, Jonathan; and Hernandez, David J., "Outcomes of Double Free Flap Reconstruction for Advanced Head and Neck Tumors in a Safety-Net Hospital Population" (2025). Research Symposium. 20.
https://scholarworks.utrgv.edu/somrs/2025/talks/20
Included in
Epidemiology Commons, Inequality and Stratification Commons, Oncology Commons, Otolaryngology Commons, Surgery Commons
Outcomes of Double Free Flap Reconstruction for Advanced Head and Neck Tumors in a Safety-Net Hospital Population
Background: Double-free flap reconstruction has emerged as a viable option for addressing more complicated defects after oncologic resection. We aim to report the feasibility of this approach at a single-institutional safety net hospital.
Methods: A retrospective chart review was performed between November 2020 and October 2023 for adult patients who underwent multiple, simultaneous free tissue transfers for head and neck defects following tumor resection. This study occurs at Ben Taub Hospital, a safety net hospital in Houston, Texas. Data collected included demographics, risk factors, oncologic and operative details, complications, and functional and disease outcomes. Socioeconomic status was assessed through the median household income (MHI) and area deprivation index (ADI). An ADI decile of 1 signifies the least disadvantaged populations, while 10 (for state) or 100 (national) represents the most disadvantaged.
Results: Between November 2020 and October 2023, 14 patients required double-free flap reconstruction. The mean (SD) follow-up time was 6.4 (4.4) months. A majority of our patients were minorities: 9 (64.3%) Hispanic, 2 (14.3%) black, 2 (14.3%) white, and 1 (8.3%) Asian. Additionally, our patients were highly socioeconomically disadvantaged. The MHI for our patient population was $52,307.00, and the median ADI was 7.5 (state decile) and 80.5 (national percentile). Thirteen (93%) patients were diagnosed with oral or oropharyngeal squamous cell carcinoma (OCSCC/OPSCC), and 1 (7%) was diagnosed with osteosarcoma of the maxilla. Thirteen (93%) patients were stage T4, 10 (71.4%) had nodal disease, and 3 (21.4%) presented with distant metastatic disease. Nine (64.3%) patients’ flaps consisted of the anterolateral thigh (ALT) and fibula, 3 (21.4%) had a double ALT combination, and 2 (14.3%) had a fibula and radial forearm free flap (RFFF). The mean (SD) length of surgery was 14 hours 54 minutes (1:35), and the mean (SD) length of stay was 19.3 (14.3) days. There were 2 partial flap losses, 0 total flap losses, 3 fistulas, 3 hematomas, 8 dehiscences, and 5 infections. Five (35.7%) patients required an unplanned return to the OR. The mean (SD) time to initiate radiotherapy postoperatively was 44.1 (6.8) days. Regarding functional outcomes, 8 (57.1%) returned to a partial or entirely oral diet, and 6 (42.9%) were either mostly or fully intelligible. Of the 11 patients that underwent tracheostomy, 8 (80.0%) were decannulated after a mean (SD) of 59.1 (75.5) days. Only 1 (7.1%) patient died within 90 days of surgery. Nine (64.3 %) patients were still alive, and 6 (43.3%) had persistent or recurrent disease at their latest follow-up. The mean (SD) time to recurrence was 6.6 (3.2) months.
Conclusion: This study demonstrates that double flap reconstruction is a viable option for reconstructing complex head and neck defects in disadvantaged patients with locally advanced malignancies. Further, it facilitates postoperative radiotherapy and provides an opportunity for functional recovery.
