Modern Oral Cavity Reconstruction with Free Flaps and Pedicled Flaps

Small defects resulting from tumor ablation can be successfully managed with primary closure (i.e., limited excisions within the oral cavity), sometimes can be left to heal for secondary intention (transoral oropharyngeal/laryngeal/hypopharyngeal resections) or can be resurfaced using skin grafts or small local flaps, but in the majority of the cases the resulting defect requires a flap transposition in order to attempt a restoration of form and function and to ensure rapid and adequate wound healing. Therefore the anticipation of the resulting defect prior to surgery is crucial in order to propose the most pertinent reconstructive solution, in this light every head and neck defect should be evaluated in terms of lack of support, cover and lining, and the chosen flap should ideally approximate the resected tissues in terms of type, thickness, texture, mobility, sensation and function. Another important aspect to consider is the need to restore a separation between different compartments; in fact the surgical approach for tumor resection can often create an iatrogenic communication between the upper aerodigestive tract and neck contents, or between oral cavity and nasal/sinonasal cavities, orbital and cranial contents.