[Microsurgical procedures in reconstructive otorhinolaryngologic surgery]

For reconstruction of bony and soft tissue defects numerous free flaps are available to the head and neck surgeon. Different tissues, as from skin, mucosa, fat, muscle or bone can be transferred by microvascular transplantation. Microvascular tissue transfer has completely replaced tissue transfer from distant donor sites and in daily routine now competes with pedicled tissue transfer. Most of the reconstructive problems can be solved by using a limited number of reliable and versatile flaps, e.g. forearm, scapular, latissimus dorsi and jejunal flap. The scapular flap offers advantages in reconstruction of extensive cervical soft tissue defects. In facial dysplasia, facial contours may be restored satisfactorily with a completely deepithelialised scapular flap. Facial soft tissue defects are closed most satisfactorily by cutaneous forearm flaps. Cutaneous scapular and forearm flaps also can be used as osteocutaneous flaps and are thus suitable for closure of additional mandibular and maxillary bony defects. The closure of large penetrating defects of the cheek is best achieved by the folded forearm flap. It also provides an ideal replacement of intraoral mucosa. For reconstruction of the tongue and the floor of the mouth the musculocutaneous latissimus dorsi flap generally shows the best functional results. In oro- and hypopharyngeal lining and replacement of the cervical oesophagus the jejunal transplant is superior to the forearm flaps.