797 Outcomes From Head-and-Neck Defect Reconstruction with Double Simultaneous Free-Flaps – a Comprehensive Analysis and Showcase of Virtual Surgical Planning Experience

Aim Extensive composite head-and-neck-defects pose significant reconstructive challenges. This study describes experiences and outcomes associated with double simultaneous free-flap (DSFF) reconstruction for malignant and traumatic head-and-neck indications. Method Retrospective study spanning consecutive DSFFs from 2013 to 2023 at Freeman Hospital (FRH), UK, and Jinnah Burn and Reconstructive Surgery Center Lahore (JSC), Pakistan. Results Nine patients (18 free-flaps) were included. All patients underwent an osteocutaneous free fibula flap commonest in combination with an anterolateral thigh (n = 3) or free radial forearm flap (n = 2). In the FRH and JSC groups respectively: mean ages were 53 years versus 27 years, cardiovascular/diabetic comorbidity rates were 60% versus 0%, surgical indications were malignancy (100%) versus trauma (100%), mean operative times were 13.7 (SD 2.8) hours versus 13.0 (SD 3.6) hours and significant complication rates were 60% versus 0%. The commonest complications were anaemia requiring transfusion (n = 3), seroma (n = 2) and wound infection or dehiscence (n = 2). All flaps survived. Virtual Surgical Plans (VSPs) derived from CT imaging were utilised in all FRH operations. Plans guided construction of custom cutting jigs for precision osteotomy, implantation of osteointegrated teeth and pre-bending of reconstructive plates. 3D-printed end-reconstructive models were employed intra-operatively to enhance surgeon visualization. Conclusions This study emphasizes the risks associated with head-and-neck DSFF reconstruction in older, comorbid patients undergoing malignancy treatment compared to the younger, less-comorbid post-traumatic reconstruction group. There were no flap losses. VSP harbours potential in improving intra-operative planning efficiency, contributing to precise reconstruction and augmenting surgeon and patient understanding.