Common Soft Tissue Free Flaps

The impact of free tissue transfer on the surgeon’s ability to reconstruct challenging defects has been revolutionary. Reconstructive surgeons face soft tissue defects daily that require using soft tissue free flaps not only to reestablish facial form and function but also to return the patient to near-pre-injury or pre-resection esthetics. Most head and neck defects can be reconstructed with few free tissue transfer donor sites. The radial forearm, latissimus dorsi, and anterolateral thigh free flaps are the cornerstone of soft tissue free flaps, with some less frequently used flaps, such as the profunda artery perforator flap (Patel, Meram, Kim, Oral Maxillofac Surg Clin North Am 31:39–68, 2019). The success of soft tissue free flaps relies substantially on a rigorous preoperative evaluation and planning. A comprehensive assessment of the patient’s medical history is essential, encompassing factors such as smoking history, atherosclerosis, peripheral vascular disease, steroid use, diabetes, previous surgeries, the extent of the defect, patient age and skin condition, and defect location (Saber, Hohman, Dreyer, Basic flap design. Statpearls, Treasure Island, 2023). In elderly patients, the presence of several age-related problems, including physiologic multiorgan function decline, but also the coexistence of multiple morbidities and geriatric syndromes, such as cognitive impairment and delirium, depression, poor nutritional status, incontinence, and falls, can have a significant impact on surgical outcomes (Grammatica, Piazza, Paderno, Taglietti, Marengoni, Nicolai, Otolaryngol Head Neck Surg 152:796–802, 2015; Mosquera, Silva, Weyh, Fernandes, Craniomaxillofacial Trauma Reconstruct, 2023). Body habitus, encompassed by the patient’s body size, shape, and adiposity, is a crucial factor in the planning and execution of soft tissue free flaps. The unique anatomical variations posed by different body habitus types can significantly impact the selection of an appropriate flap and the surgical approach. This chapter will review the workhorse soft tissue free flaps that have become an indispensable resource for reconstructive surgeons.