Methodologic issues in the comparison of microsurgical flaps/techniques in head and neck reconstruction

This article informs head and neck microsurgeons, investigators, and readers of the head and neck microsurgical literature about key methodologic issues when comparing techniques/flaps in head and neck reconstruction. The following is discussed: (1) the principles of evidence-based microsurgery, (2) the hierarchy of the strength of evidence for treatment decisions in microsurgery, (3) types of questions asked (background and foreground questions) to identify the best available evidence, (4) strategies for searching the head and neck microsurgical literature, (5) issues regarding study outcomes (types, perspective, and time horizon) in microsurgery, (6) the relevance of incorporating economic analyses into head and neck microsurgical trials, and (7) the interpretation and applicability of published study results to an individual microsurgeon's clinical practice.