The Future of Bioengineering for Head and Neck Reconstruction: The Customized Free Flap

The successful reconstruction of complex defects in the head and neck region may require significant expertise and experience on the part of the maxillofacial surgeon. In the majority of cases, restoration of both esthetics and function can be satisfactorily achieved by the use of autogenous non-vascularized grafts or vascularized free flaps. Stringent patient selection is critical to the success of these techniques and includes requirements such as treating target defects with adequate soft tissue volume, an intact donor site, and healthy individuals without significant wound healing impairment. In many cases, multiple surgical revisions may be needed to achieve the desired outcomes. With the increase in healthcare costs and number of patients with complex comorbidities, tissue engineering has provided a plethora of strategies for cases that may not be ideal for traditional surgical approaches. In this chapter, we present tissue engineering strategies that are both current in clinical practice and ongoing in research trials. These approaches range from the use of a prefabricated space maintainer to optimize the wound environment prior to the final reconstruction to the utilization of an in vivo bioreactor in generating autologous tissue biologically and geometrically tailored to the target defect. The appreciation of emerging bioengineering strategies will serve informed surgeons well in optimizing surgical planning for the reconstruction of complex maxillofacial defects.