Microvascular Flaps in Head & Neck Reconstruction

7.11.1 Name some common fasciocutaneous, musculocutaneous and osseocutaneous free flaps used in H&N reconstructions. What is the blood supply (and nerve, if applicable) to each?

7.11.2 What are the Indications and advantages of free tissue transfer in H&N reconstruction?

Shestak KC, Myers EN, Ramasastry SS, Johnson JT, Jones NF. Microvascular free tissue transfer for reconstruction of head and neck cancer defects. Oncology (Williston Park). 1992 May;6(5):101-10; discussion 110, 115-6, 121. PMID:1534669

7.11.3 What is an angiosome? What are choke vessels?

7.11.4 Flap delay procedure. What, when, why, how?

7.11.5 What is ischemia-reperfusion injury? What is the no-reflow phenomenon?

7.11.6 Role for leeches in salvage of compromised flap. How do they work? Complications?

7.11.7 What is the best way to monitor free flaps? How can you tell if a flap is failing?

Neligan PC. Monitoring techniques for the detection of flow failure in the postoperative period. Microsurgery. 1993;14(3):162-4. PMID:8479313

Kind GM, et al. The effect of an implantable Doppler probe on the salvage of microvascular tissue transplants. Plast Reconstr Surg. 1998 Apr;101(5):1268-73; discussion 1274-5. PMID:9529212

7.11.8 What are the success rates of free tissue transfer (FTT) ? In radiated beds? The elderly? Smokers? Common complications of FTT?

al Qattan MM, Boyd JB. Complications in head and neck microsurgery. Microsurgery. 1993;14(3):187-95. PMID:8479317

7.11.9 Discuss the role for anti-coagulants in free tissue transfer. What are some commonly used drugs and how do they work?

Davies DM. A world survey of anticoagulation practice in clinical microvascular surgery. Br J Plast Surg. 1982 Jan;35(1):96-9. PMID:7066596

Glicksman A, et al. 1457 years of microsurgical experience. Plast Reconstr Surg. 1997 Aug;100(2):355-63. PMID:9252602