David E Schuller L Arick Forrest and Amit Agrawal

Since the publication of the first successful transfer of a free flap for oral cavity reconstruction by Panje et al.,1 the use of microvascular surgery for tissue transfer to reconstruct defects within the head and neck has flourished. The initial reports primarily involved discussions of the feasibility and reliability of this highly specialized tissue transferring technique.2-4 Other publications included descriptions of the type of reconstructions that could be successfully accomplished with free flap transfer.5-8

The objectives of any reconstructive technique are to preserve function and reestablish form. The refinements of head and neck reconstructive techniques over the past 20 years have enhanced the ability of the otolaryngologist-head and neck surgeon to achieve these goals in many cases, but there continue to be times when both cannot be achieved. When a variety of techniques are available that are reported to achieve the same goal, there is the potential for confusion and controversy as to which is the most appropriate technique. That is certainly the case with the array of tissue transfer approaches that are currently available to contemporary otolaryngologist-head and neck surgeons involved in facial reconstruction. This book deals with controversies, as well as a discussion of the topic of the role of free flaps in head and neck reconstruction within that theme.

It is the goal of this chapter to identify those issues that are relevant to the controversies concerning the role of free flaps in head and neck surgery, in an effort to help the reader identify the issues. Thus, decisions about utilization can be made in an objective fashion based on factual information. The chapter includes discussions of the advantages and disadvantages of free flaps and identifies issues that continue to be unresolved about the use of this technique. The use of free flaps for a variety of reconstructive tasks is also discussed.

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