Orochi Flaps in Head and Neck Reconstruction.

BACKGROUND

Multiple simultaneous free flap reconstructions for extensive head and neck defects in vessel-depleted necks are extremely challenging. The Orochi flap, in which 1 or more secondary free flaps are anastomosed to the main pedicle of a primary free flap, resulting in a fabricated chimeric flap, may be a useful option when recipient vessels are scarce.

METHODS

Orochi free flap reconstructions for head and neck defects performed from 2005 through 2024 were reviewed. Postoperative outcomes were compared with those of traditional free flaps and vein-grafted free flaps using multivariable regression and propensity score matching.

RESULTS

Seventy-two Orochi flaps were compared with 385 traditional flaps and 47 vein-grafted flaps. The flap loss rate was 0% for primary Orochi flaps and 4% for secondary Orochi flaps. Only vein-grafted flaps (odds ratio, 68.7 [95% CI, 2.6 to 1788.6]) and history of free flaps (odds ratio, 44.2 [95% CI, 2.2 to 879.4]) were found to be independent predictors of total flap loss on multiple regression analysis. In propensity score-matched analysis, Orochi flaps were associated with shorter median hospital stays (8 versus 10 days [ P < 0.05]) and vein-grafted flaps were associated with higher rates of overall complications (21% versus 8.3% [ P = 0.037]) and total flap loss (7.1% versus 0% [ P = 0.035]) compared with traditional flaps.

CONCLUSION

Orochi flaps are a reliable option for head and neck reconstruction requiring multiple simultaneous free flaps in patients with vessel-depleted necks and may offer advantages over vein grafting to reach recipient vessels at distant sites.