Method Of Soft Tissue Reconstruction Research Articles

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

The superficial peroneal neurocutaneous flap: a cadaveric study

Soft tissue defects around the ankle are common and must be covered with thin and pliable flaps. A regional flap, particularly from the dorsum of the foot was considered ideal. A neurocutaneous flap, based on the superficial peroneal nerve (SPN) and its branches was designed as a proximally based flap via cadaveric dissection. This study aimed to demonstrate the vascularity and characteristics of the superficial peroneal neurocutaneous (SPNC) flap. The SPNC flap was created in 11 lower limbs (seven cadavers) using a proximally based design. The skin flap was dissected at the dorsum of the foot, followed by injection of diluted methylene blue through the anterior tibial artery, to visualize the vascularity. The flap pedicle above the anterior ankle joint line was dissected along the SPN for anatomical study of perforating branches, paraneural vessels, and flap territory. The mean distances of the most proximal perforating branches were 1.51 ± 1.48 cm from the anterior ankle joint line, and 5.12 ± 1.78 cm from the lateral malleolus. The mean distances of the most distal perforating branches were 2.75 ± 1.54 cm from the anterior ankle joint line, and 5.90 ± 1.81 cm from the lateral malleolus. The mean number of perforating branches was 3.73 ± 1.49. The mean flap territories were 5.51 ± 0.59 cm in length, and 7.15 ± 0.64 cm in width. The SPNC flap is an alternative method for soft tissue reconstruction around the ankle with a proximally based flap design. The antegrade flow has been shown to offer effective vascularity in flaps prepared via cadaveric dissection.

Use of a bilayer biodegradable synthetic dermal matrix for the management of defects arising from necrotising fasciitis.

The aim of this article is to provide a brief overview of necrotising fasciitis, including causative factors, incidence, diagnosis and clinical outcomes. Various surgical treatment options are outlined, including methods of soft tissue reconstruction after wide excision of infected and necrotic tissues. The role of dermal matrices, including a synthetic biodegradable temporising matrix made of polyurethane, are described in terms of wound bed preparation, surgical application and clinical outcomes.

Soft tissue reconstruction using fasciocutaneous flaps in compound fracture tibia: A case series

Objective: To study the role fasciocutaneous flap as a method of soft-tissue reconstruction in open tibial fractures soft-tissue defect and to compare their outcome when used as early coverage with that of delayed coverage. Materials and Methods: A total of 30 patients with open tibial fractures (type IIIB) were subjected to fasciocutaneous flap for the soft-tissue defect. Patients were divided into two groups based on the timing of soft-tissue reconstruction comprising of 15 patients in each group. Group I the early group (0-7 days) and group II delayed group (8-30 days). Results: Road traffic accidents accounted for the majority of fractures with 77.7% and 60% in group I and group II. The right leg was involved in 20 patients (66.7%) and left leg in 10 patients (33.33%). Middle one-third of the leg being the predominant site of wound defect 66.7% and 60% in group I and group II respectively. 66.7% of superficial infection was found with the delayed closure (group II) and 46% with early closure (group II). 26.7% of deep bony infection was found to be with the delayed closure and 20% with early closure. 80% of flap survived completely in group I while 73.3% flap survived in group II. In group I the time to union was between 13 weeks and 25 weeks accounting for 73.3% of the cases and in group II the time to union was between 26 weeks and 52 weeks, which accounted for 80% of the cases. The average hospital stay was 13.4 days in group I with 80% ranging in between 10 days and 20 days and in group II the average stay was 22.8 days with 53.3% ranging from 21 days to 30 days. Conclusion: The goals of soft tissue coverage in open fractures are to achieve a safe and early durable coverage, avoid nosocomial infection and optimize the healing and facilitate the future reconstruction.

The proximally pedicled anterolateral thigh flap for reconstruction of complex soft tissue wounds of the hip and caudal trunk region

Groin and lower trunk defects are common problems, especially for elderly patients. While groin defects are often due to prior vascular interventions, trochanteric defects are mainly caused by pressure sores. Plastic reconstructive methods are manifold; however, the pedicled anterolateral thigh (ALT) flap is supposed to be reliable with sustainable results. We present our experiences using the pedicled ALT flap for soft tissue reconstruction in patients with large wounds of the medial and lateral proximal thigh. A total of 16 patients with groin and lower trunk defects due to prior vascular surgery or pressure sores received locoregional soft tissue reconstruction using aproximal pedicled ALT flap. Patient characteristics, defect size, surgery time, clinical outcome and complication rate were assessed. With the exception of two cases, sufficient soft tissue reconstruction was achieved. In all, 81,3% of patients were categorized as ASA (American Society of Anesthesiologists)3. The average duration of surgery was 149 min. Length of stay was 18,3days. A total of 31% needed revision surgery due to limited wound healing problems. Two patients died. All patients showed healed wound conditions when they were discharged. The proximal pedicled ALT-flap is areliable method for soft tissue reconstruction in groin and lower trunk defects. This reconstructive procedure enables reliable wound closure, especially in elderly patients with substantially reduced general health condition.

Corrigendum: Visual Depictions of Our Evolutionary Past: A Broad Case Study Concerning the Need for Quantitative Methods of Soft Tissue Reconstruction and Art-Science Collaborations

Corrigendum: Visual Depictions of Our Evolutionary Past: A Broad Case Study Concerning the Need for Quantitative Methods of Soft Tissue Reconstruction and Art-Science Collaborations

Visual Depictions of Our Evolutionary Past: A Broad Case Study Concerning the Need for Quantitative Methods of Soft Tissue Reconstruction and Art-Science Collaborations

Flip through scientific textbooks illustrating ideas about human evolution or visit any number of museums of natural history and you will notice an abundance of reconstructions attempting to depict the appearance of ancient hominins. Spend some time comparing reconstructions of the same specimen and notice an obvious fact: hominin reconstructions vary in appearance considerably. In this review, we summarize existing methods of reconstruction to analyze this variability. It is argued that variability between hominin reconstructions is likely the result of unreliable reconstruction methods and misinterpretation of available evidence. We also discuss the risk of disseminating erroneous ideas about human evolution through the use of unscientific reconstructions in museums and publications. The role an artist plays is also analyzed and criticized given how the aforementioned reconstructions have become readily accepted to line the halls of even the most trusted institutions. In conclusion, improved reconstruction methods hold promise for the prediction of hominin soft tissues, as well as for disseminating current scientific understandings of human evolution in the future.

Versatility of the inferiorly based nasolabial flap for reconstruction in early oral cancer patients: Our experience in a tertiary cancer centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The nasolabial flap is a simple, yet efficient method of soft tissue reconstruction with a very reliable blood supply which can be used to reconstruct soft tissue defects of various parts of the oral cavity. Aim of the study was to study the effectiveness of the inferiorly based nasolabial flaps for reconstruction in early oral cancer patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 28 patients with T1 or T2 malignant lesions of the oral cavity were studied retrospectively who underwent reconstructions using the inferiorly based nasolabial flap. Flap viability, wound problems, infections, function, scar and recurrence were noted post-operatively for all the patients included in the study. All patients were followed up for a minimum of 6 months after the surgery. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The nasolabial flap was used to reconstruct defects of buccal mucosa, oral commissure, lower lip, lateral border of the tongue, hard palate and the floor of the mouth. The flap was viable in all patients with no recurrences. Cosmetic and functional outcomes were good. However few patients developed minor complications like post-operative trismus, severe wound contracture, ectropion and infection and wound dehiscence. Intra oral hair growth over the flap used were one of the main problems in the majority of male patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;If proper attention is given to flap designing, operative technique and post-operative management, the NLF is a viable and versatile option for reconstruction of small to intermediate defects of the oral cavity created post ablation of early tumors of the oral cavity.&lt;/p&gt;

Reverse sural artery fasciocutaneous flap in soft tissue reconstruction in lower extremity

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg.&#x0D; Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0.&#x0D; Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics.&#x0D; Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

REVERSE SURAL ARTERY FASCIOCUTANEOUS FLAP IN SOFT TISSUE RECONSTRUCTION IN LOWER EXTREMITY

Background: Soft tissue defect around distal leg, ankle and heel region is a challenging task for an orthopaedic surgeon. Sural artery reverse fasciocutaenous flap has been widely used and is a successful method for soft tissue reconstruction in such situation. This study aimed to find out the result of sural artery distal based pedicle flap in managing soft tissue recon­struction around the ankle and distal leg. Methods: This was a retrospective study of 12 cases of sural artery based fasciocutaenous flap done between January 2015 to December 2019. Medical records were used to find the details of demographic data, operative details and post-operative status of the patients. Patients were contacted for the final follow up at minimum of 6 months after operation for assessment of the outcome. Demographic and clinical data were entered in excel chart and the clinical result was analyzed using SPSS software version 20.0. Results: There were total of 12 patients who underwent sural artery flap procedure. Among them, 10 were male and 2 females with mean age of 39 (range, 25-52) years. Eleven flaps survived with satisfactory functional outcome. One had complete flap necrosis, two had patchy margin necrosis and two had superficial infection which healed well with minor debridement and antibiotics. Conclusions: Sural artery based reverse fasciocutaenous flap is good and technically easier option for an orthopaedic surgeons for the soft tissue reconstruction around ankle, heel and distal leg in traumatic, infective or other etiology with satisfactory outcome in most of the patients.

Rectus abdominis free tissue transfer in lower extremity reconstruction: Long term follow up in 58 cases

This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for lower extremity reconstruction. MethodsOver a period of 8 years 58 were available for long term follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. ResultsAt a mean follow-up of 18 years, there were no major complications in the soft tissue defect coverage group except for one patient who continued to have recurrent folliculitis over the weight bearing heel area, which was treated by repeated debridement. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. ConclusionsThe rectus abdominis free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis

A study of autologous free fat transplantation for augmentation of contour deformities of face: a study of 10 cases with review of literature

Increased understanding, improving technology and the latest advances along with growing emphasis on the operative details over a period of last 100 years are the important factors due to which, 'free fat transplant' is now becoming a method of choice for reconstruction of soft tissue deformity of face. Although it requires initial overfilling of the fat and also considering the possibility of uncontrolled, unpredicted absorption of the injected fat, transplant of the free fat itself being a simple and cost effective procedure has emerged out to be a treatment of choice for contour deformities of face and is preferred over other methods of soft tissue reconstruction for the face. It gives natural look and feel to the tissue and also has less post-operative consequences comparatively. Here we present our experience of free fat auto-transplant for soft tissue reconstruction of face by taking into account ten cases in whom, we performed the procedure and kept a follow-up to obtain the exact status of results, benefits and complications. Also we are comparing our result with that mentioned in the literature and presenting it with a review.

Interscapulothoracic resection of tumours of shoulder with a note on reconstruction.

We retrospectively reviewed the outcomes of 33 consecutive patients who had undergone an extra-articular, total or partial scapulectomy for a malignant tumour of the shoulder girdle between 1 July 2001 and 30 September 2013. Of these, 26 had tumours which originated in the scapula or the adjacent soft tissue and underwent a classic Tikhoff-Linberg procedure, while seven with tumours arising from the proximal humerus were treated with a modified Tikhoff-Linberg operation. We used a Ligament Advanced Reinforcement System for soft-tissue reconstruction in nine patients, but not in the other 24. The mean Musculoskeletal Tumor Society score (MSTS) was 17.6 (95% confidence interval (CI) 15.9 to 19.4); 17.6 (95% CI 15.5 to 19.6) after the classic Tikhoff-Linberg procedure and 18.1 (95% CI 13.8 to 22.3) after the modified Tikhoff-Linberg procedure. Patients who had undergone a LARS soft-tissue reconstruction had a mean score of 18.6 (95% (CI) 13.9 to 22.4) compared with 17.2 (95% CI 15.5 to 19.0) for those who did not. The Tikhoff-Linberg procedure is a useful method for wide resection of a malignant tumour of the shoulder girdle which helps to preserve hand and elbow function. The method of soft-tissue reconstruction has no effect on functional outcome.

Fasciocutaneous flap as a method of soft tissue reconstruction in open tibial fractures

Objective: To study the role fasciocutaneous flap as a method of soft-tissue reconstruction in open tibial fractures soft-tissue defect and to compare their outcome when used as early coverage with that of delayed coverage. Materials and Methods: A total of 30 patients with open tibial fractures (type IIIB) were subjected to fasciocutaneous flap for the soft-tissue defect. Patients were divided into two groups based on the timing of soft-tissue reconstruction comprising of 15 patients in each group. Group I the early group (0-7 days) and group II delayed group (8-30 days). Results: Road traffic accidents accounted for the majority of fractures with 77.7% and 60% in group I and group II. The right leg was involved in 20 patients (66.7%) and left leg in 10 patients (33.33%). Middle one-third of the leg being the predominant site of wound defect 66.7% and 60% in group I and group II respectively. 66.7% of superficial infection was found with the delayed closure (group II) and 46% with early closure (group II). 26.7% of deep bony infection was found to be with the delayed closure and 20% with early closure. 80% of flap survived completely in group I while 73.3% flap survived in group II. In group I the time to union was between 13 weeks and 25 weeks accounting for 73.3% of the cases and in group II the time to union was between 26 weeks and 52 weeks, which accounted for 80% of the cases. The average hospital stay was 13.4 days in group I with 80% ranging in between 10 days and 20 days and in group II the average stay was 22.8 days with 53.3% ranging from 21 days to 30 days. Conclusion: The goals of soft tissue coverage in open fractures are to achieve a safe and early durable coverage, avoid nosocomial infection and optimize the healing and facilitate the future reconstruction. fasciocutaneous flap can reliably and effectively cover traumatic open tibial fractures soft tissue defect.Advantage of fasciocutaneous; they have their own blood supply producing a good durable cover and can be reopened for bony surgery.

Use of the transverse carpal ligament for soft tissue reconstruction of a Mannerfelt lesion

In 1969, Mannerfelt described the “critical corner” where the flexor pollicis longus (FPL) tendon tends to rupture from abrasion against osteophytes from the scaphotrapezial joint in patients with rheumatoid arthritis [2]. He further suggested that removal “of the spur and covering of the floor…may have saved these tendons from later attritional rupture.” Since then, it has been recognized that debridement of osteophytes and soft tissue reconstruction, to separate the arthritic wrist joint from the carpal canal, are important to avoid recurrent rupture following tendon reconstruction. The currently accepted method of soft tissue reconstruction uses the adjacent capsulo-ligamentous transposition flap to cover the exposed bone (Fig. 1) [1]. Although the transposition flap appears simple in illustration, we have found this approach to be difficult. The flap is limited in size and does not transpose easily, the donor site is difficult to close, and the soft tissue tends to be of poor quality. In the case of a large defect, a local transposition flap is inadequate to reline the carpal canal. Fig. 1 The recommended reconstruction for Mannerfelt lesions from Green's Operative Hand Surgery (reproduced with permission from Wolfe SW, Hotchkiss RN, Pederson WC, et al., editors, Green's Operative Hand Surgery, 6th edition We have utilized an alternative to the traditional approach of a local transposition flap. A large, radially based flap of the transverse carpal ligament can be used to resurface and reconstruct the volar soft tissues of the wrist along the carpal canal. Given the technical ease of this alternative approach, we report a case and revisit the management of the Mannerfelt lesion.

Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction

We have previously reported on the efficacy of free-tissue transfer in ankle and foot reconstruction with a mean follow-up period of 3.7 years (9 months-7.5 years) postoperatively. This study will evaluate the long-term results of free-tissue transfer performed for soft tissue defect coverage, diabetic foot salvage and the treatment of chronic osteomyelitis in 38 patients. The long-term efficacy of free-tissue transfer for foot and ankle reconstruction was evaluated in a retrospective study among patients operated during a period of 5 years (January 1992-December 1996); 38 were available for follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. At a mean follow-up of 12 years, there were no major complications in the soft tissue defect group. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. The free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.

Commentary on ?Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis? by Scheker LR, Boland MR

The technique of ligament suspension after trapeziectomy described in this paper by Scheker and Boland represents considerable sophistication of the original concept of “ligament reconstruction—tendon interposition” (LRTI) described by Burton and Pellegrini [1]. The elaboration of the routing of the tendon slip of FCR is ingenious, and has the purpose of providing more direct ligamentous control of the metacarpal base to prevent both dorsal subluxation and proximal migration of the metacarpal, and a cushion between the first and second metacarpal bases. There is no doubt that the procedure is technically more demanding. After more than 200 operations it is not surprising that a master-surgeon such as Dr Scheker makes the operation appear simple, but any surgeon planning to embark on this procedure in preference to more simple versions of the operation should be prepared for some difficulty in matching Dr Scheker’s expertise, and his results. It would certainly be advisable for a less experienced surgeon to observe the operation in the hands of an experienced exponent. Dr Scheker’s results, taken together with the large size of the series, are impressive, and compare well with those reported by Tomaino et al. [2] in a small series, although the latter noted some fall in power over 9 years compared to 6, and there is some confusion in their paper about the preoperative and postoperative key pinch measurements which make direct comparison difficult. The opposite approach to Dr Scheker’s is to simplify rather than elaborate the reconstruction, and Davis et al. [3] have shown no difference between their results with or without LRTI. Long-term results are not yet available. The results in terms of pain relief are not obviously different from Scheker and Boland’s, although the methods of evaluation are not easily comparable. Davis et al. showed much less improvement in strength, so the precise method of soft tissue reconstruction may be the important factor. In particular, Davis et al. question the importance of preventing proximal migration of the metacarpal, and there may be grounds to speculate on the ability of a ligament reconstruction, however strong to start with, to prevent gradual migration over the long term. All series of trapeziectomy will have a small proportion of disappointing results, and for some the reason may be amenable to prevention; persistent scaphotrapezoid arthritis can be anticipated by joint excision, and first metacarpal adduction deformity avoided by maintaining control of a hypermobile first MP joint, either with a temporary k-wire during the period of splintage, or by MP fusion. Any surgeon who feels that he or she can master Scheker and Boland’s technique can be confident that the results will be among the best achievable, but those planning to change from a method that works for them should be aware of the increased complexity and technical demands of this operation.

Lateral Upper Arm Free Flap for Primary Reconstruction of Pharyngeal Defects in Ablative Oncological Surgery

Free microvascular flaps are an established method for soft tissue reconstruction following ablative oncological surgery in the head and neck. Functional reconstructions of the hypopharynx and the pharyngoesophageal segment (PES) are of particular relevance, as they are highly demanding surgical procedures. So far, the radial forearm free flap (RFFF) and the free jejunal transfer have been the transplants predominantly used for this purpose. The lateral upper arm free flap (LUFF) presents an alternative method for the fasciocutaneous tissue transfer. We report on our experience with the LUFF in a 56-year-old male patient with a pT3pN0M0 squamous cell carcinoma of the hypopharynx. A pharyngocutaneous fistula developed 5 days after pharyngolaryngectomy with bilateral neck dissection. The fistula was localized between the pharyngeal constrictor muscle and the esophagus and was closed with an LUFF from the left arm. Excellent flap adaptation to the remaining pharyngeal mucosa was observed. Although the length of the vascular pedicle and the diameter of the vessels in the LUFF are smaller than those in the RFFF, neither pedicle length nor vessel diameter proved to be a problem. The LUFF can be recommended as a well-vascularized, relatively safe and reliable flap for reconstruction of tubular structures such as the hypopharynx and the PES after tumor ablation and as an alternative to the RFFF. The flexibility of the LUFF allows surgeons to reconstruct the anatomy of the lost soft tissues as adequately as possible.

Principles of management of high-energy injuries of the leg

High-energy traumas are open or closed injuries caused by force (missile, traffic injuries, crush or blust injuries, falling from heights), affecting the body surface and transferring high amount of kinetic energy inducing great damage to the tissue. Management of such lower extremity injuries has evolved over past several decades, but still remains a difficult task for every surgical team. Specific anatomic and functional characteristics combined with extensive injuries demands specific treatment protocols. In a multiple injured patient the first priority is management of life-threatening trauma. Despite other injuries, surgical treatment of limb-threatening injuries must start as soon as life-threatening condition has been managed. Algorithms are especially beneficial in management of severely injured, but salvageable extremities and in making decision on amputation. Insight into mechanisms of injury, as well as systematic examination of the affected limb, should help us understand the extensiveness of trauma and make an adequate management plan. Prevention of wound infection and surgical approach to high-energy limb trauma, which includes wound extension, wound excision, skeletal stabilization and if necessary muscle compartment release, should be done in the first 6 hours after injury. Commonly used methods for soft tissue defects must provide wound coverage in less than five days following injury. Early passive and active mobilization and verticalization of patients is very important for successful treatment. Good and timely evaluation of the injured and collaboration between plastic and orthopaedic surgeons from the beginning of treatment, are crucial for final outcome.

Reconstruction of soft tissue defects in the oral cavity and oropharynx.

During the decade following its description by Ariyan and Baek et al in 1979, the pectoralis major myocutaneous flap was widely considered to be the “workhorse” flap for reconstruction of major soft tissue defects of the oral cavity and oropharynx. This flap’s reliability and the good to excellent outcome with its use inhibited exploration of other more versatile techniques of reconstruction. Although the first microscope-assisted transfer of a free flap was reported in 1973, and microvascular head and neck reconstruction was described in 1976, initially there was limited enthusiasm in the United States to apply free flaps for head and neck reconstruction. This reluctance arose from several perceived potential shortcomings of microvascular tissue transfer. Such concerns included questions regarding the reliability of a technique that was dependent on smallvessel vascular anastomoses for a successful outcome and the potential for an adverse impact on the costs and complications of therapy. The pectoralis major myocutaneous flap was the preferred method for reconstruction of significant soft tissue defects at our institution until the late 1980s, when initial efforts were undertaken to investigate the potential utility of free flaps for head and neck reconstruction. Initially, free flaps were only chosen for reconstruction of selected patients for whom our previous reconstructive efforts using regional flaps had been disappointing (eg, patients with segmental defects of the anterior mandibular arch). During the past decade, our favorable experience with microvascular free tissue transfer has resulted in an evolution of our reconstructive philosophy, so that free flaps are now the preferred method of soft tissue reconstruction when primary mucosal repair or skin grafting would be insufficient in patients who undergo surgical therapy for cancers of the oral cavity and oropharynx. This includes patients with soft tissue resection of many T2 and most T3/T4 tumors, as well as some patients who undergo lateral composite mandibulectomy, in whom a soft tissue free flap is used in conjunction with a bridging mandibular reconstruction plate. We will review our experience with soft tissue free-flap reconstruction of the oral cavity and oropharynx and compare it with the results of regionalflap and free-flap reconstruction reported in the literature to determine whether our current reliance on free flaps is justified. PRO