Next generation of head and neck free flap reconstruction: the future of innovation and refinement

Purpose of review We briefly review the history of surgical innovation in free flap reconstruction of the head and neck. With a specific focus on maximizing patient QoL by prioritizing a ‘precision reconstruction’, we then posit novel avenues for surgical refinement to usher in the next generation of head and neck free flap reconstruction. Recent findings Patients undergoing free flap reconstruction of the head and neck increasingly co-prioritize preservation of quality-of-life (QoL) alongside the desire to survive their diagnosis. In the contemporary era, this fact has prompted microvascular surgeons to customize reconstructive plans to minimize decisional regret and maximize favorable functional and cosmetic outcomes for their patients. Increasingly popular strategies for surgical refinement and innovation in this space include novel flap harvest techniques, unconventional flap donor sites, and use of flow-through configurations, all of which are routinely utilized in our group's practice. Additional strategies gaining traction in head and neck reconstruction include vascular perfusion imaging with indocyanine green fluorescence angiography and ‘Jaw-in-a-Day’ surgeries leveraging computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies. Summary The next frontier of innovation in free flap reconstruction of the head and neck will prioritize custom, patient-specific reconstructions that consider the unique anatomic, functional, and aesthetic needs of each patient (i.e. precision reconstruction).