Advantages

Microvascular surgery provides the capability of reestablishing blood flow to a variety of tissues transferred into the head and neck from distant sites, so that reconstruction can be completed in one operation. This is in contrast to other tissue-transferring techniques, such as regional flaps, which often require a second operation to detach the pedicle of the tissue used in reconstruction. The only regional flap that provides for immediate one-stage transfer of tissue into the defect comparable to free flap techniques are the musculocutaneous flaps. But free flaps oftentimes provide greater versatility than the regional flaps, including the musculocutaneous flaps, because the thickness of the tissue can be controlled by the selection of a particular free flap. A free flap can be thick, such as the musculocutaneous rectus abdo-minis free flap, or it can be quite thin, such as the fasciocuta-neous radial forearm free flap. This ability to select the thickness of tissue represents a unique advantage for the free flaps.

Free flaps also provide an opportunity to transfer a variety of types of tissue into the head and neck. Depending on the selection of free flap, it is possible to transfer skin and subcutaneous tissue as a single entity, as well as muscle, fascia, bone, and even nerve-muscle combinations to achieve goals of reanimation. This flexibility to transfer a combination of different types of tissue facilitates surgical creativity to tailor precisely the reconstruction to the defect by replacing the type of tissue that has been destroyed by cancer or trauma. It therefore provides an enhanced ability to achieve the objectives of restoration of form and preservation of function that is superior to alternative reconstructive techniques.

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