Microvascular reconstructive surgery of the head and neck

The favoured method of reconstruction for large head and neck defects after resection for cancer is microvascular free flaps. Success rates in excess of 95% can be achieved in major centers. Especially pharyngeal defects are very challenging to reconstruct functionally. For the major subsites within the pharynx we describe our preferred method, mainly based on the application of the thin pliable radial forearm flap. However, in some instances a bulky flap, such as the rectus abdominis flap is needed. For reconstruction of the pharyngo-esophagus the tubed forearm flap is currently most often used. Functional results and quality of life are very acceptable to good after these extensive procedures. Harvesting of the radial forearm flap yields mild but distinct morbidity and warrants addressing.