Simultaneous double free flaps reconstruction may be necessary in the patients with advanced oral cancer, especially in composite extensive defects involving oral mucosa, skin, mandible, muscles and soft tissues.

Materials and methods: Patients. We retrospectively reviewed our patient’s database from Feburary 2001 to August 2012. We treated 237 oral cancer patients using 296 free flaps consecutively. Of these, 25 patients received simultaneous double free flap reconstructions after tumor ablation.

Results: Of the 25 double free flap reconstructions, 4 patients were in Stage III, while the rest were in Stage IV of oral squamous cell carcinoma. 16 cases received fibula plus radial forearm free flaps, whereas 9 cases received fibula plus anterolateral thigh free flaps. The mean dimension of the outer lining was 97.0 cm ² (30–132), while the inner lining measured 104.0 cm ² (56–150). The average length of the harvested fibula bone was 15.1 cm (12–20). The mean anesthesia time was 19.81 h and the flap failure rate was 4.0%, as two fibula flaps failed due to artery thrombosis. The re-exploration rate was 24%, 5 cases were due to venous thrombosis, the other one due to artery occlusion. No patients died of postoperative complications. The mean follow up time was 20.4 months and 76% of the patients are still alive as of their last visits. For the expired cases, the average survival time was 19.0 months postoperatively.

Conclusion: For large composite defects of the face and neck, two free flaps should be the best combination for reconstruction. Double free flaps do not only cover large raw surface areas, but can also rebuild three-dimensional, complicated facial defects like oral commissure for example.