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Clinical Challenges
July 2000

Reconstruction of Soft Tissue Defects in the Oral Cavity and Oropharynx

Author Affiliations

Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2000

Arch Otolaryngol Head Neck Surg. 2000;126(7):909-912. doi:10.1001/archotol.126.7.909

Free flaps are superior to local or regional flaps for reconstruction of significant soft tissue defects in the oral cavity and oropharynx.

During the decade following its description by Ariyan1 and Baek et al2 in 1979, the pectoralis major myocutaneous flap was widely considered to be the "workhorse" flap for reconstruction of major soft tissue defects of the oral cavity and oropharynx. This flap's reliability and the good to excellent outcome with its use inhibited exploration of other more versatile techniques of reconstruction. Although the first microscope-assisted transfer of a free flap was reported in 1973,3 and microvascular head and neck reconstruction was described in 1976,4 initially there was limited enthusiasm in the United States to apply free flaps for head and neck reconstruction.5 This reluctance arose from several perceived potential shortcomings of microvascular tissue transfer. Such concerns included questions regarding the reliability of a technique that was dependent on small-vessel vascular anastomoses for a successful outcome and the potential for an adverse impact on the costs and complications of therapy.