Purpose of review: This article reviews literature pertaining to the evolution in head and neck reconstruction techniques over the past two decades, specifically the changing patterns of usage of locoregional flaps and microvascular free tissue transfer.
Recent findings: Most literature demonstrates a continuing trend favoring microvascular free tissue transfer for the majority of large defects. A few pedicled flaps, some new and some resurrected, now provide expanded and sometimes superior options for certain head and neck defects. Considerations driving flap choice include defect composition, oncologic, aesthetic, and functional factors.
Summary: Although osteocutaneous microvascular free flaps remain the standard of care for composite oromandibular defects, there may be a groundswell in the use of certain locoregional pedicled flaps for reconstructing many facial, intraoral and pharyngeal soft tissue defects. Evolution in the use of these locoregional flaps may help improve upon the standard of care for reconstructive options.