Abstract
Complex head and neck defects requiring double free flap reconstruction present unique
challenges in vascular design. Flow-through configurations, where one flap's arterial
supply feeds a second flap, offer theoretical advantages but create inherent vulnerabilities.
This seminar examines the hemodynamic and geometric principles underlying flow-through
reconstruction, analyzes common failure mechanisms, and provides practical guidelines
for surgical decision-making. Key concepts include retrograde thrombus propagation,
cumulative pressure drops in series circuits, and the non-Newtonian properties of
blood that complicate theoretical predictions. Understanding these principles is essential
for appropriate patient selection and technical execution in complex reconstructive
cases.
Keywords
free flap - flow-through - hemodynamics - microsurgery - head and neck reconstruction
