Distinguishing between patients whose defects can be reconstructed by more conventional techniques and those who would benefit from free-tissue transfer is critical in achieving a successful outcome. Such factors as the size and location of the defect, its complexity, and compromised wound situations attributable to preoperative radiation therapy and infection may predispose to the use of free flaps.1 For example, we now consider free flaps the most reliable technique for reconstruction of the mandible and full circumferential pharyngeal defects. It is the technique of choice in our department. In other cases, when selecting a method of reconstruction, we give careful consideration to preoperative functional status and to the patient's expectations. For some patients, the use of skin grafts and regional muscle pedicle flaps continues to play an important role in reconstruction of defects in the head and neck. In each case, success depends on understanding the functional and cosmetic aspects of the defect that will be created and selecting the flap most appropriate for the given site in the head and neck.
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