Strategies for avoiding complications with vascularized bone flaps in head and neck microvascular reconstruction

Area of Science:

• Reconstructive surgery
• Head and neck oncology
• Vascularized bone grafting

Background:

• Osseous reconstruction in the head and neck is a recent advancement.
• Free flap techniques using common donor sites (iliac crest, fibula, radius, scapula) are now standard.
• Less common sites like calvarium offer specific reconstructive advantages.

Purpose of the Study:

• To illustrate refinements and potential pitfalls in vascularized osseous reconstruction of the head and neck.
• To discuss the use of established free flaps and the calvarium flap.
• To emphasize strategies for error avoidance in complex reconstructive scenarios.

Main Methods:

• Review of established free flap donor sites: iliac crest, fibula, radius, scapula.
• Discussion of calvarium as a specialized donor site.
• Analysis of reconstructive challenges across various pathologies and comorbidities.

Main Results:

• Common donor sites provide reliable options for head and neck reconstruction.
• The calvarium flap is valuable for specific, complex defects.
• Less common donor sites (femur, humerus, rib) have shown variable reliability.

Conclusions:

• A comprehensive "toolbox" of reconstructive options is essential for head and neck osseous reconstruction.
• Understanding refinements and pitfalls of well-recognized flaps improves outcomes.
• Careful selection of donor sites based on defect characteristics and patient factors is crucial.