Vascularized free-tissue transfer in head and neck surgery.

Microsurgical vascularized free-tissue transfer has had a dramatic impact on the field of head and neck reconstruction. This technique has extended the extirpative limits of resection by facilitating complex reconstruction of head and neck defects in one stage with very high success and minimal patient morbidity. Although its impact on improving cure rates and survival statistics has yet to be determined, it has proven very valuable in the palliation of patients with advanced malignancies. The horizons for future applications are infinite. Neurotization of free-flap transfer may potentially improve the functional outcome for patients. In the future, free flaps may be prefabricated to allow for improved mandibular reconstruction or tracheal reconstruction. These tissue composites may potentially be a vehicle through which adjuvant therapy can be better delivered to the tumor bed. Microsurgical free-tissue transfer will have an expanding role in the treatment of patients with head and neck tumors, and continued refinements in these techniques will open new vistas for the reconstructive surgeons in the future.