Free microvascular tissue transfer. Clinical significance in reconstructive surgery of the head and neck

Abstract

Free microvascular anastomosed tissue transfer has improved the reconstruction of soft tissue defects dramatically. For reconstruction of facial and cervical soft tissue defects numerous free flaps are available to the head and neck surgeon, however, most of the reconstructive problems can be solved by using a limited number of reliable and versatile techniques. In microvascular tissue transfer, the scapular flap offers similar advantages as to reliability and versatility as the pectoralis major flap in pedicled tissue transfer. In contrast to the scapular flap the groin flap is more bulky, its skin is soft and may carry pubic hair on its medial aspect. After partial maxillectomy or in facial dysplasia facial contour may be restored satisfactory with a completely or partially de-epithelialized scapular flap. In total hypopharyngeal and cervicoesophageal defects the jejunum transplant provides an ideal tubular replacement. If after resection of an intraoral carcinoma with partial mandibulectomy an osteocutaneous transfer has to be achieved the mandibular defect may be reconstructed with bone from the iliac crest or from the radius while the intra- and extraoral tissue defect may be closed with the adjacent skin flaps. For the closure of large penetrating defects of the cheek the inferior epigastric abdominal wall flap in particular has proved a versatile and reliable flap. This flap offers both, a cutaneous and a peritoneal surface. Latter is used for the replacement of the intraoral lining.