Published online Feb 28, 2015. doi: 10.5319/wjo.v5.i1.5
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.
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.