Microsurgical Reconstruction of Oncological Defects

Microsurgical reconstruction for defects from tumor ablations commonly involves breast, head and neck, extremities, and trunk. The goals of microsurgical reconstruction is to provide soft tissue coverage for bony defects, as well as functional and contour restoration. Recently, donor site minimization has also become an important focus in flap designs. In flap selections, a cutaneous flap is the preferred option over a muscle flap, a perforator flap is preferred over a myocutaneous flap, and a fibula osteoseptocutaneous flap is preferred over an iliac and scapula osteocutaneous flap. An anterolateral thigh perforator flap is preferred over a radial forearm flap. Accurate assessment of the defects, appropriate donor flap selection, delicate recipient site preparations, precise microsurgical anastomoses, and flap insets are the key factors for successful reconstruction with maximal functional and cosmetic outcome. Deep inferior epigastric perforator flaps, anterolateral thigh flaps, radial forearm flaps, and fibula osteoseptocutaneous flaps are the most commonly used flaps. By understanding the anatomy and surgical techniques of these common flaps, surgeons can confidently reconstruct varieties of oncological defects. Microsurgical reconstruction is applicable to most oncological defects of the entire body as it has a high success rate with low reexploration and complication rates. The use of microsurgical techniques for reconstruction is limited by restricted microsurgical skill and potential donor site morbidity.