Abstract
Free-flap reconstruction of head-and-neck defects is often complicated by a vessel-depleted neck after prior surgery or radiotherapy. Conventional alternatives-such as using contralateral vessels, distant recipient vessels, or interpositional vein grafts-are technically demanding and associated with additional risks. We present two salvage reconstructions in which the vascular pedicle of a previously transferred free flap was reused as recipient vessels when standard options were unavailable. A 79-year-old man developed exposure of a titanium mandibular plate 6 years after mandibular resection reconstructed with a free anterolateral thigh (ALT) flap. Preoperative ultrasonography and contrast-enhanced computed tomography confirmed patency of the ALT flap pedicle despite dense fibrosis. After removal of the exposed plate, the pedicle was carefully dissected, and a scapular osteocutaneous flap (9 × 12 cm skin, 2.5 × 11 cm bone) was anastomosed to the lateral circumflex femoral artery and vein of the existing pedicle. Both flaps survived, and postoperative cholecystitis was managed conservatively. In another case, a 63-year-old man with a history of reconstruction using a free ALT flap for recurrent temporal meningioma developed another recurrence 2 years later. Imaging confirmed patency of the previous pedicle. During salvage surgery, the pedicle was dissected, and a free rectus-abdominis flap (9 × 20 cm) was harvested. Arterial anastomosis was performed to the artery of the previous ALT pedicle, and venous drainage was established directly into the internal jugular vein due to insufficient pedicle vein caliber. Intraoperative indocyanine green fluorescence angiography confirmed flap perfusion, and both flaps healed uneventfully. These cases show that reusing the vascular pedicle of a prior free flap may provide a practical salvage option in vessel-depleted necks. Careful preoperative imaging, intraoperative assessment of flap viability, and meticulous microsurgical technique are essential for success. This approach suggests that pedicle reuse may simplify salvage reconstruction while preserving previously transferred flaps when conventional recipient vessels are unavailable.