Recent advances in reconstruction in the head and neck region

A better understanding of the detailed blood supply of skin and its underlying soft tissue has provided the reconstructive surgeon with a wider choice of reliable skin and muscle flaps for the reconstruction of head and neck defects after ablative surgery. The forehead, cervical and delto-pectoral flaps have been the standard flaps used for head and neck reconstruction. More recently, myocutaneous flaps like the pectoralis major myocutaneous flap and the latissimus dorsi myocutaneous flap have been used for head and neck reconstruction. The skin of these flaps provides the lining tissue and the muscle provides support as well as bulk and therefore greatly increases the scope of functional as well as cosmetic reconstruction. Finally, fat sculpturing techniques done as a secondary procedure on these myocutaneous flaps enables defects in the contour of the reconstructed face to be symmetrical with the normal side. This paper summarises the various flaps used in reconstruction of the head and neck region and discusses in detail the most promising myocutaneous flap for head and neck reconstruction in use today - the pectoralis major myocutaneous flap.