In situations where existing techniques of reconstruction are inadequate or involve multiple stages, free-flap transfer offers major advantages for the head and neck surgeon. Wider application of free-flap surgery has been inhibited by problems of flap design and graft take. Thrombosis at the microanastomic site, particularly at the venous site, is still a cause of failure. Techniques of anastomosis are of paramount importance. Nakayama ring pin anastomosis is easier to learn, less time-consuming, and shows less early thrombosis that suture techniques. Use of adjunctive pharmacologic agents, such as the tetrahydroimidazo quinazolines, will increase the likelihood of success.
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