Future Directions

The development of free flap reconstruction for the head and neck began with skepticism regarding the safety and reproducibility of transferring tissue to the head and neck. We are now in a second phase in which questions regarding the true value of these techniques in changing the quality of a patient's life are being raised.5 The future success of free flaps seems secure as we gain greater understanding of the pathophysiology of small vessel thrombosis, improvements in instrumentation, and utilization of flaps with longer vascular pedicles. We must continue to ensure that the high level of flap success continues as the techniques become more popular and widely disseminated. Increasingly, otolaryngologists are being exposed to microvascular techniques at both the residency and fellowship levels. One study identified 27 fellowships per year offering some microvascular training within the field of otolaryn-gology-head and neck surgery.47 Close cooperation between head and neck cancer surgeons, microvascular head and neck surgeons, and plastic and reconstructive surgeons is imperative as we move into the second era of free flap evolution. Future studies in this field need to consider cosmetic, functional, and quality-of-life outcomes as more meaningful interpretations of free flap reconstruction, rather than flap survival alone.47 There are relatively few objective reports in this area, especially in head- and neck-specific quality-of-life measures for free flap reconstruction. As we become more capable of extirpating larger tumor volumes and more sophisticated in our reconstructive techniques, we must not lose sight of the impact of these procedures on the lives of our patients.

Song and Myers—CHAPTER 14

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44. Kim KA, Chandrasekhar BS. Cephalic vein in salvage micro-surgical reconstruction in the head and neck. Br J Plast Surg 1998;51:2-7

45. Brown DH, Mulholland S, Yoo JHH, et al. Internal jugular vein thrombosis following modified neck dissection: implications for head and neck reconstruction. Head Neck 1998;20:169-174

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The Role of Free Flaps in Head and Neck Reconstruction

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