Free flaps to the head and neck

Early attempts at microvascular reconstruction in the head and neck area with free tissue flaps failed, leading some authors to feel that these techniques would have a limited role, especially when such flaps had to be used in recipient sites in which they were in contact with saliva or when the microvascular anastomoses had to be done with recipient vessels that had been irradiated. Today, however, many aspects of neck and facial reconstruction routinely use composite free tissue transfer. These methods are the first choice for reconstruction in traumatic amputations and repair of large mandibular defects, and for some facial contour and skin loss situations. Free composite tissue transfer is an excellent alternative for esophageal reconstruction (small bowel) and has great potential for facial animation (free muscle) and total nose reconstruction (dorsalis pedis).