Microvascular free flaps in head and neck reconstruction.

Microvascular free tissue transfer can be applied to head and neck reconstruction where: (a) conventional flaps have been used successfully, (b) conventional flaps are extremely difficult to use and such procedures are undertaken with reservation and (c) conventional flaps cannot accomplish the reconstructive goal. The authors describe examples of these applications and summarize their experience in their first 10 cases. All flaps survived completely; there were four minor complications. Reconstruction with microvascular free flaps has many advantages over conventional techniques. The flap tissue retains its vascularity-important in irradiated tissue-there are no open wounds and this single-stage procedure is associated with a high rate of flap survival. Specifically, the flap can be oriented with ease, without restriction caused by a tight pedicle. The donor sites are less conspicuous and previous use of conventional donor sites is not important. Most importantly compound skin and bone flaps can be used simultaneously to reconstruct mandibular and lining defects. This application is not possible wtih techniques other than free flap transfer.