Principles of microvascular reconstruction and concepts for addressing extreme situations

Today, free tissue transfer is a standard procedure in all oral and maxillofacial departments with a focus on tumor surgery. The high level of expertise in flap raising and microvascular anastomosis that has been acquired since the introduction of this technique regularly leads to high success rates and enables even extensive resections with predictably satisfactory results in terms of function and esthetics. Especially in mandibular reconstructions have procedures and results been further improved by the virtual patient-specific planning methods that are widely used today. While in principle almost any resectable tumor can be treated surgically in patients who are eligible to undergo surgery, challenges remain-regardless of the overall oncological situation-if surgery and radiation have already been performed. In these patients, free tissue transfer can be methodologically difficult or even impossible due to the limited or non existent availability of recipient vessels. In this article, the most important standard flaps as well as techniques that are not of routine nature are presented to emphasize the necessity of ongoing scientific engagement in this topic, which is of existential importance for our specialty.