Preparation of the neck for microvascular reconstruction of the head and neck.

Reconstruction of congenital, developmental, or acquired head and neck defects remains a significant challenge for the oral and maxillofacial surgeon. Microvascular free tissue transfer has several advantages over nonvascularized bone grafts and pedicled soft tissue flaps that currently make it the modality of choice for the reconstruction of extirpative defects of the head and neck. Preoperative planning must include detailed attention to the technical aspects of the microvascular procedure. This includes a thorough understanding of the vascular anatomy of the patient's neck; vascular anatomy of the various flaps including pedicle lengths; and a knowledge of how to facilitate microvascular surgery in the neck and to manage complicating factors in the difficult neck.