# Sequential flaps reconstruction in head and neck cancer: A systematic review

## TL;DR

This paper reviews the use of sequential flaps for reconstructing head and neck defects in cancer patients, finding them effective with a high survival rate.

## Contribution

The study systematically reviews sequential flap outcomes in head and neck cancer reconstruction, highlighting the anterolateral thigh flap as the most commonly used.

## Key findings

- Sequential flaps had a 94.6% survival rate in head and neck cancer reconstruction.
- The anterolateral thigh flap was the most frequently used sequential flap type.
- Flap-related complications included revision, necrosis, and thrombosis.

## Abstract

•Sequential flaps can be used as an effective method for head and neck reconstruction.•The survival rate of sequential flaps was 94.6%.•The anterolateral thigh flap is the mostly used sequential flap type.

Sequential flaps can be used as an effective method for head and neck reconstruction.

The survival rate of sequential flaps was 94.6%.

The anterolateral thigh flap is the mostly used sequential flap type.

For patients with Head and Neck Cancer (HNC), flap reconstruction is one of the treatment modalities for large head and neck defects. While most patients achieve satisfactory outcomes with a single flap, some may require a second or additional flaps due to various reasons. The aim of our study was to systematically review the relevant articles and investigate the application of sequential flaps in reconstruction of patients with HNC.

Two authors independently screened articles from PubMed, EBSCO, and Web of Science. Studies were included if they reported at least one of the following outcomes: duration of operation or hospitalization, flap-related postoperative complications, flap success rate, and follow-up outcomes.

A total of 17 articles were included, comprising 832 patients and 1037 flaps (excluding the number of flaps used in initial reconstructions). The overall flap failure rate was 5.4%. Among the 314 flap-related postoperative complications, the most common were revision (5.8%), complete flap necrosis (5.2%), and arterial or venous thrombosis (3.3%).

Sequential flaps are an optional and effective reconstructive modality for HNC patients. However, prospective studies are needed to explore prognostic-related risk factors and better determine the suitability of sequential flaps for individual patients. Additionally, since reconstruction impacts both aesthetics and function, it is crucial to emphasize during preoperative discussions that postoperative outcomes may not fully align with patient expectations.