Principles of Soft Tissue Free Flap Reconstruction in Head and Neck Cancer

Reconstruction of soft tissue defects of the head and neck region is both challenging and unforgiving due to demanding aesthetic and functional requirements. The wide variation in defect anatomy, unique patient circumstances and the plethora of flap possibilities mean that each case must be individualised. The ALT flap is the workhorse soft tissue flap but can be bulky. The MSAP and radial forearm flaps provide thin, pliable tissue but are less versatile. A high rate of free flap survival is possible with meticulous preparation of flap and recipient vessels, careful attention to pedicle positioning and accurate vessel anastomosis.