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Over the last decade, few aspects of the specialty of oral and maxillofacial surgery have advanced as much as reconstructive surgery. The advent of microvascular free flaps with or without bone, in particular, has caused a paradigm shift in our ability to reconstruct previously difficult defects due to their size or position. Bony reconstruction of the mandibular midline and long-span osseous defects can now be managed more predictably. Soft tissue free flaps allow for large areas of the head and neck to be reconstructed both functionally and esthetically. However, like most surgical procedures, free flap reconstructions have their downsides. They are technically complex, time-consuming procedures with significant potential for morbidity and failure. In addition, some patients are not candidates for free flaps due to vascular compromise, age, or comorbidities.
Local and regional flaps have long been used for reconstruction in the head and neck. Due to the extensive blood supply in the head and neck, these flaps are generally safe and predictable. Smaller procedures, such as the facial artery myomuscular flap (FAMM flap), platysma flap, tongue flap, paramedian forehead, and nasolabial flaps, can be used when the defect does not call for large tissue mass. In addition, these flaps are relatively easy and quick and are capable of being performed by most oral and maxillofacial surgeons. Larger procedures, such as the pectoralis major and latissimus dorsi flap, can be used as primary reconstructive flaps in patients not suited for free flap reconstruction or as salvage procedures after failure of free flaps.
Having at least some of these procedures in their armamentarium will benefit every surgeon. The cancer reconstructive surgeon will most certainly need the pectoralis major flap sooner or later, but even those surgeons that primarily perform intraoral surgery will gain from having experience with palatal, FAMM, and tongue flaps. During the course of their career, every surgeon experiences that moment when they find themselves facing a soft tissue defect during or after surgery that defies primary closure, by design or unexpectedly. It is both prudent and comforting to have knowledge of some or all of these local and regional flaps when in that situation.
We were very fortunate to have such a distinguished group of authors agree to contribute to this issue of Oral and Maxillofacial Surgery Clinics of North America. We are truly grateful for their willingness to participate. In addition, all guest editors of Oral and Maxillofacial Surgery Clinics of North America rely on John Vassallo and Yonah Korngold, the resident editors at Elsevier, who provide expert advice and guidance. Without them, this issue would not have been possible.