Head and neck reconstructive surgery: what the radiologist needs to know

Head and neck reconstructive surgery after cancer ablative surgery is now commonly performed with closure of the surgical defects by microvascular free tissue transfer. The most common flaps used for reconstruction are the radial forearm flap, the anterolateral thigh flap and fibula flap. Radiographic appearance of these flaps depends on the individual components of the flap, and may consist of skin, fat, muscle and/or bone. There are various adverse outcomes in these patients, the most significant being tumour recurrence that typically occurs at the flap margins. Other flap complications include flap necrosis from vascular thrombosis or infection. The goal of this article is to enhance radiologists’ familiarity with different methods of flap reconstruction, flap margins and vascular anastomoses that will lead to a better appreciation of expected postoperative radiographic appearance. Key Points • Flaps are the most common reconstructive techniques used in neck cancer surgery. • Imaging appearance of flaps depends on their components and time since surgery. • Most tumour recurrence after reconstruction occurs at the margins of the flap.