title: The evolving role of free flaps and pedicled flaps in head and neck reconstruction.
abstract: OBJECTIVE
  This article reviews literature pertaining to the evolution in head and neck reconstruction techniques over the past two decades, specifically the changing patterns of usage of locoregional flaps and microvascular free tissue transfer.
  
  
  RESULTS
  Most literature demonstrates a continuing trend favoring microvascular free tissue transfer for the majority of large defects. A few pedicled flaps, some new and some resurrected, now provide expanded and sometimes superior options for certain head and neck defects. Considerations driving flap choice include defect composition, oncologic, aesthetic, and functional factors.
  
  
  CONCLUSIONS
  Although osteocutaneous microvascular free flaps remain the standard of care for composite oromandibular defects, there may be a groundswell in the use of certain locoregional pedicled flaps for reconstructing many facial, intraoral and pharyngeal soft tissue defects. Evolution in the use of these locoregional flaps may help improve upon the standard of care for reconstructive options.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona 85054, USA. hayden.richard@mayo.edu
authors.forename: Richard E
authors.initials: RE
authors.lastname: Hayden
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Nagel
mesh_terms: D058752:Free Tissue Flaps / Q000098:blood supply; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008833:Microcirculation; D019651:Plastic Surgery Procedures / Q000639:trends*; D013524:Surgical Flaps / Q000098:blood supply