Microvascular reconstruction in the head and neck.

With the advent and refinement of microvascular surgical techniques, the results of reconstruction in the head and neck area have been substantially improved. Free flaps can now be moved in one stage for reconstruction of composite tissue in the head and neck area, whereas multiple procedures were often necessary to accomplish such reconstructions in the past. Skin, fat, muscle, bone, and intraoral lining can all be reestablished by using microvascular techniques. Because of the availability of microvascular surgical procedures, defects caused by cancer, congenital anomalies, or acquired disorders can now be reconstructed successfully. This article summarizes the history of microvascular operations and the development of the techniques and equipment; in addition, free tissue transfer reconstruction is compared with traditional techniques. The selection of the appropriate donor tissues and the assessment of patients preoperatively are discussed, and several illustrative case reports are presented.