A brief history of vascularized free flaps in the oral and maxillofacial region.

Vascularized free flaps are now the reference standard for the reconstruction of defects after cancer resection in oral and maxillofacial surgery and other specialties and have an interesting and surprisingly long history. We reviewed the history of free flap use in oral and maxillofacial surgery and show their place in the wider context of surgical progress. An overview is given of both soft tissue and bony reconstruction in the pre-free flap era and the development of vascular anastomosis and microsurgery--one of the main foundations of free flap surgery. The emergence of free flaps from 1959 through to the early 1970s is documented. The history of 19 of the more common free flaps used in oral and maxillofacial surgery is described, from the jejunal flap in 1959 through to the posterior tibial artery flap in 1985. For each, the origin and first reported use in the head and neck are discussed. Free flap surgery has continued to evolve, with developments in perforator and chimeric flaps, and new flaps continue to be described. An appreciation of the surgical history is important in understanding where we are today. Our review should give the practicing surgeon an idea of the origins of the currently used techniques.