Use of multiple free flaps in head and neck reconstruction.

To review the recent literature on the use of multiple flaps in head and neck reconstruction with attention to form, function, outcomes, and complications. Multiple free flap reconstructions are technically feasible with high flap survival rates, tolerable complication rates, and overall adequate functional and aesthetic outcomes, given the large extent of the defects and the high surgical complexity of these cases. Multiple free flap reconstructions should be considered in cases of large defects involving multiple functional regions and tissue types, which most often arises following resection of advanced malignancies. As there is mortality benefit with clear surgical margins and eradication of malignant lymph nodes, larger resections should be pursued if necessary, followed by a multiple flap reconstruction.