title: Microsurgical free flaps: Controversies in maxillofacial reconstruction.
abstract: Reconstructive microsurgery for oral and maxillofacial (OMF) defects is considered as a niche specialty and is performed regularly only in a handful of centers. Till recently the pectoralis major myocutaneous flap (PMMC) was considered to be the benchmark for OMF reconstruction. This philosophy is changing fast with rapid advancement in reconstructive microsurgery. Due to improvement in instrumentation and the development of finer techniques of flap harvesting we can positively state that microsurgery has come of age. Better techniques, microscopes and micro instruments enable us to do things previously unimaginable. Supramicrosurgery and ultrathin flaps are a testimony to this. Years of innovation in reconstructive microsurgery have given us a reasonably good number of very excellent flaps. Tremendous work has been put into producing some exceptionally brilliant research articles, sometimes contradicting each other. This has led to the need for clarity in some areas in this field. This article will review some controversies in reconstructive microsurgery and analyze some of the most common microvascular free flaps (MFF) used in OMF reconstruction. It aims to buttress the fact that three flaps-the radial forearm free flap (RFFF), anterolateral thigh flap (ALT) and fibula are the ones most expedient in the surgeon's arsenal, since they can cater to almost all sizeable defects we come across after ablative surgery in the OMF region. They can thus aptly be titled as the workhorses of OMF reconstruction with regard to free flaps.
authors: Department of Head & Neck Oncology & Reconstructive Surgery, Cancer Institute (W.I.A), Adyar, Chennai, India.
authors: Rinku K
authors: RK
authors: George
authors: Arvind
authors: A
authors: Krishnamurthy
keywords: Microvascular free flaps; oral and maxillofacial surgery; reconstructive microsurgery
references: Ann Plast Surg. 2001 Oct;47(4):385-9
references: 11601572
references: J Oral Maxillofac Surg. 1997 May;55(5):440-8; discussion 448-9
references: 9146512
references: Head Neck. 2004 Nov;26(11):930-6
references: 15508120
references: Br J Plast Surg. 2000 Jan;53(1):30-6
references: 10657446
references: Otolaryngol Head Neck Surg. 2007 Aug;137(2):182-91
references: 17666238
references: Arch Otolaryngol Head Neck Surg. 2001 Jul;127(7):862-9
references: 11448364
references: Br J Plast Surg. 1984 Apr;37(2):149-59
references: 6713155
references: Eur Arch Otorhinolaryngol. 2008 Jan;265(1):85-95
references: 17690895
references: Plast Reconstr Surg. 2005 Nov;116(6):1659-68; discussion 1669-71
references: 16267429
references: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Jun;99(6):671-6
references: 15897852
references: Arch Otolaryngol Head Neck Surg. 1998 Nov;124(11):1206-8
references: 9821921
references: Head Neck. 1999 Jan;21(1):66-71
references: 9890353
references: Microsurgery. 2004;24(5):374-7
references: 15378583
references: Clin Plast Surg. 1994 Jan;21(1):97-105
references: 8112018
references: Plast Reconstr Surg. 1999 Feb;103(2):403-11
references: 9950525
references: Ann Plast Surg. 2006 Aug;57(2):159-63
references: 16861995
references: J Surg Oncol. 2006 Nov 1;94(6):538-45
references: 17061277
references: Br J Plast Surg. 2004 Oct;57(7):603-9
references: 15380693
references: Am J Surg. 1994 Nov;168(5):425-8
references: 7977966
references: Plast Reconstr Surg. 1999 Jan;103(1):39-47
references: 9915162
references: Am J Surg. 1991 Oct;162(4):404-7
references: 1951899
references: Auris Nasus Larynx. 2004 Sep;31(3):269-73
references: 15364362
references: Plast Reconstr Surg. 1996 Apr;97(5):985-92
references: 8619002
references: Arch Otolaryngol Head Neck Surg. 2004 Jul;130(7):813-8
references: 15262756
references: Ann Chir Plast Esthet. 2008 Oct;53(5):420-3
references: 18055087
references: Otolaryngol Head Neck Surg. 2002 Sep;127(3):205-12
references: 12297811
references: J Craniomaxillofac Surg. 2003 Aug;31(4):197-201
references: 12914703
references: J Plast Reconstr Aesthet Surg. 2009 May;62(5):e85-6
references: 19054723
references: Head Neck. 2009 Oct;31(10):1289-96
references: 19373778
references: J Craniofac Surg. 2008 Nov;19(6):1577-82
references: 19098555
references: J Plast Reconstr Aesthet Surg. 2007;60(6):588-92
references: 17485045
references: Br J Plast Surg. 2001 Sep;54(6):487-90
references: 11513509
references: Eur Ann Otorhinolaryngol Head Neck Dis. 2011 Apr;128(2):47-51
references: 21237737
references: Plast Reconstr Surg. 1999 Oct;104(5):1307-13
references: 10513910
references: Laryngoscope. 2002 Dec;112(12):2161-5
references: 12461333
references: Plast Reconstr Surg. 1979 Apr;63(4):525-33
references: 424461
references: Laryngoscope. 2003 Sep;113(9):1473-6
references: 12972917
references: Plast Reconstr Surg. 1979 Dec;64(6):745-59
references: 390575
references: Laryngoscope. 1991 Sep;101(9):935-50
references: 1886442
references: Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):181-6
references: 14967747
references: Int J Oral Maxillofac Surg. 2008 Aug;37(8):723-9
references: 18562173
references: Head Neck. 2003 Jul;25(7):549-53
references: 12808658
references: Plast Reconstr Surg. 2006 Oct;118(5):122e-133e
references: 17016169
references: Oral Oncol. 2005 Aug;41(7):738-46
references: 15978858
references: Plast Reconstr Surg. 1999 Sep;104(4):916-21
references: 10654728
references: Laryngoscope. 2003 May;113(5):905-9
references: 12792331