Microsurgical workhorse flaps in head and neck reconstruction

The aim of reconstruction after resection of head and neck tumors is to achieve acceptable functional and esthetic results with minimal donor site morbidity. Although many flaps have been developed for bone and soft tissue reconstructions, our experience in the past years has identified the anterolateral thigh flap (cutaneous or myocutaneous), the radial forearm flap, and the osteoseptocutaneous fibula flap as the most useful flaps for head and neck reconstruction. These three flaps can be used for reconstruction of almost all kinds of defects, either as a single flap or in combination. The harvest of these flaps is relatively simple and straightforward. All flaps have adequate pedicle vessel length and caliber. Donor site morbidity is negligible. As most reconstructive microsurgeons do not have enough patient volume to master many different kinds of flaps in their professional life, we recommend focusing on these three flaps as workhorse flaps instead of hunting for many other flaps for head and neck reconstruction.