Two-team approaches in modern head and neck oncologic and reconstructive surgery: ablative considerations

Purpose of review Two-team approaches to head and neck cancer ablation and free flap reconstruction now occur concurrently in most centers. While the functional outcomes after head and neck ablation and reconstruction are typically examined through the lens of the reconstructive surgeon, optimizing the patient's functional outcome requires careful considerations of the entire surgical team. This review summarizes important intraoperative considerations for decision making by the surgical team, with a particular emphasis on ablative considerations, to optimize reconstructive outcomes after tumor extirpation. Recent findings Intraoperatively, dynamic and deliberate communication between the ablative and reconstructive surgeons are critical in two-team approaches. Surgical principles such as thoughtful skin incision planning, atraumatic dissection of neck vessels, preservation of draining veins in the neck, preservation of nerves to maximize sensation of the native tissue, atraumatic handling of native mucosa, and communication in planning osteotomies of the mandible and maxilla may help to optimize functional outcomes after reconstruction. Summary In two-team approaches to head and neck cancer ablation and free flap reconstruction, a focus on communication, flexibility, and trust between surgeons are of paramount importance. Importantly, the goals of the ablative and reconstructive surgeons are interdependent, yet in our experience, optimal reconstructive outcomes begin with the thoughtful peri-operative decision-making and intraoperative preservation of critical structures by the surgical team.