Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Otorhinolaryngol. Feb 28, 2015; 5(1): 5-13
Published online Feb 28, 2015. doi: 10.5319/wjo.v5.i1.5
Vessel selection and free flap monitoring in head and neck microvascular reconstruction
Ryan M Smith, Vicky Kang, Samer Al-Khudari
Ryan M Smith, Vicky Kang, Samer Al-Khudari, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ryan M Smith, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 550, Chicago, IL 60612, United States.
Telephone: +1-312-9426100 Fax: +1-312-9426653
Received: September 28, 2014
Peer-review started: September 28, 2014
First decision: October 28, 2014
Revised: December 13, 2014
Accepted: January 15, 2015
Article in press: January 15, 2015
Published online: February 28, 2015

Microvascular free flap surgery has become a successful and reliable method of reconstruction following head and neck cancer resection. The effectiveness of free flap reconstruction has increased with improved surgical technique as well as technological refinement in vessel selection and flap monitoring. Few papers have studied the factors that influence success or failure rates of free flap reconstructions, particularly with an eye towards the technologic advancements that have refined the procedure in the last several decades. Here we present a comprehensive review of perioperative and intraoperative considerations that influence free flap outcomes as well methods of vessel selection and flap monitoring important during microvascular reconstruction of the head and neck.

Keywords: Neck dissection, Free flap, Microvascular anastomosis, Mandibulectomy, Head and neck cancer

Core tip: Microvascular free flap reconstruction of the head and neck has become a successful and reliable procedure important in the treatment of head and neck cancer. Careful consideration of the donor site, strategies for vessel selection, and intra- and post-operative flap monitoring protocols and procedures are crucial for successful free tissue transfer. In this review, we present an overview of the latest techniques and technologies proven useful during free flap surgery including strategies for vessel selection, the use of computer aided modeling programs, indocyanine green near-infrared angiography, and ultrasonic transit-time flowometry.