Microvascular flaps in head and neck surgery

In our practice tho radial forearm flap, the lateral ar-rn flap, the scapular and parascapular skin- and bone-flap, the latissimus dorsi flap and the jejunum are used for reconstruction of the head and neck. The forearm flap and the lateral arm flap are suitable for reconstruction of the oral cavity and pharynx. For tongue reconstruction the flap is folded in an omega shape. In tl-lis region jejunum neither as a patch nor as a tube is used in our clinic since it often shows postoperative complications and in addition the donor morbidity is rather high. Also for reconstruction of the hypopharynx nd cervical esophagus the forearm flap is sutured in a U-shape to the prevertebral fascia. Further the radial forearm flap is used in reconstruction of the outer surface of the head and neck especially in large and flat defects if the defect is too big for local or regional flaps. Also reconstruction of the nose and the lips is possible with this flap. For deep defects the scapular- or the latissimus dorsi flap is useful especially if reconstruction needs to include coverage of dura or brain. The latissimus dorsi flap also can be harvested as a pure muscle flap for example for reconstruction of the anterior skull base and obliteration of the orbit and surgical cavities of thc paranasal sinuses. The latissimus dorsi muscle flap can also be covered with split skin. For reconstruction of bone beside iliac crest scapula and fibula grafts can be harvested. Iliac crest however possesses the best bone volume. The only intraabdominal flap which for some occasions in augmentation surgery is used is the omentum. For augmentation further the desepithelialized scapula flap plays a certain role. Microvascular free flaps allow an adequate individual, defect-orientated reconstruction for functional and esthetic impairment in head and neck surgery.