Technology in microvascular surgery.

With the refinement of microvascular technique, free-tissue transfer has emerged as the standard of care in head and neck reconstruction. Success rates and reductions in operative time have reduced "flap take" from being the marker of reconstructive success to being an expectation. Interest has now shifted to improvement of technique, with surgeons placing increasing importance on donor site morbidity, quality of tissue harvested, and esthetic and functional outcomes. Much of the recent success can be attributed to technological advance through improvement in instrumentation and technique and enhancement of the understanding of flap physiology and anatomy. This article reviews some of the recent advances and how they have affected microvascular surgery from preoperative, operative, and postoperative standpoints.