Microsurgical free flaps: Controversies in maxillofacial reconstruction

Area of Science:

• Oral and Maxillofacial Surgery
• Microsurgery
• Plastic Surgery

Background:

• Reconstructive microsurgery for oral and maxillofacial (OMF) defects is a specialized field with evolving techniques.
• The pectoralis major myocutaneous flap (PMMC) was previously the standard, but advancements have introduced new options.
• Contradictory research necessitates a review of current practices and flap selection.

Purpose of the Study:

• To review controversies in reconstructive microsurgery for OMF defects.
• To analyze the most common microvascular free flaps (MFFs) used in OMF reconstruction.
• To highlight the efficacy of specific MFFs for various OMF defects.

Main Methods:

• Review of current literature on reconstructive microsurgery for OMF defects.
• Analysis of the utility and application of common MFFs.
• Comparison of flap characteristics and outcomes.

Main Results:

• Microsurgery techniques and instrumentation have advanced, enabling complex reconstructions.
• The radial forearm free flap (RFFF), anterolateral thigh flap (ALT), and fibula flap are highly versatile and effective for OMF reconstruction.
• These three flaps can address a wide range of defects encountered after ablative surgery in the OMF region.

Conclusions:

• The RFFF, ALT, and fibula flaps are the 'workhorses' for OMF reconstruction using MFFs.
• These flaps offer a reliable and expedient solution for most OMF defects.
• Continued innovation in microsurgery supports the use of these versatile flaps.