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The anterolateral thigh (ALT), radial forearm free flap (RFFF), medial sural artery perforator (MSAP) flap, and latissimus dorsi (LD) flap are traditionally considered workhorse options for soft tissue reconstruction of the head and neck region. Although reliable, each presents specific limitations. This study evaluates the systematic use of alternative, “atypical” flaps as primary reconstructive options.

Clinical experience from 2021 to 2024 at the cantonal hospitals of Lucerne and Winterthur, Switzerland, is presented. During this period, superficial circumflex iliac artery perforator / superficial inferior epigastric artery (SCIP/SCIA–SIEA) and profunda artery perforator (PAP) flaps were routinely employed as primary reconstructive choices. Their performance, advantages, and limitations were evaluated in comparison with traditional workhorse flaps

SCIP/SCIA–SIEA and PAP flaps proved suitable for small to medium-sized defects, with favorable donor-site acceptance. Abdominal-based SCIP/SCIA–SIEA flaps were technically more demanding but allowed harvesting of larger skin paddles when required. In only 3 cases out of more than 60 reconstructions, intraoperative conversion was necessary (to radial forearm, ALT, and DIEP flaps, respectively).

In this experience, SCIP/SCIA–SIEA and PAP flaps functioned effectively as primary reconstructive options. Familiarity with these techniques may broaden the reconstructive armamentarium in head and neck surgery.

Free fibula flap reconstruction is a cornerstone technique for skeletal reconstruction in the head and neck region. However, clinical practice often requires continuous adaptation of reconstructive strategy to defect morphology, soft tissue conditions, and recipient vessel anatomy. This study aimed to evaluate temporal changes in flap design, inset strategy, and microvascular techniques and to assess their association with reconstructive outcomes.

A retrospective analysis was performed on 83 free fibula flap reconstructions in 81 patients undergoing craniofacial reconstruction between 2007 and 2018. The cohort was divided into two time periods (2007–2012 and 2013–2018). Demographics, indications, reconstructive sites, flap composition, use of chimeric designs, flap orientation, anastomotic techniques, and recipient vessel selection were compared. Statistical analyses were conducted to identify significant temporal trends.

Patient demographics were comparable between periods, while oncologic indications increased significantly in the later period. A significant rise in osteomyocutaneous flaps was observed, along with a trend toward increased use of chimeric designs. Flap orientation shifted markedly toward contralateral inset techniques. Use of venous coupler anastomoses and dual venous drainage increased significantly over time. Recipient vessel selection shifted toward the internal jugular vein. The overall flap loss rate was 6 percent, with all losses occurring in the early period and associated with ipsilateral inset and hand-sewn venous anastomosis.

Free fibula flap reconstruction demonstrates substantial technical versatility and benefits from continuous refinement of reconstructive strategy. Increased use of osteomyocutaneous designs, contralateral inset techniques, dual venous drainage, and coupler-assisted anastomoses were associated with improved reliability. These findings emphasize the importance of adaptive surgical planning beyond standardized algorithms to achieve stable reconstructive outcomes.

Reconstructing complex head and neck defects requires versatile tissue. While the anterolateral thigh (ALT) is the gold standard , a systematic selection algorithm for alternative thigh donor sites is needed for complex or recurrent scenarios.

This five-year retrospective study analyzed 957 thigh-based free flap reconstructions (860 ALT; 97 non-ALT variants including PMT, TFL, AMT, and LMT) following oncological resections. Outcomes were stratified by de novo versus recurrent status.

The overall success rate was 96.65%. Complications occurred in 14.2% of cases, with no significant difference between flap types (p = 0.93). Recurrent cases using non-ALT flaps had a significantly higher failure rate (12.29%) compared to fresh cases (0%) (p = 0.039). Vein grafts were required in only 0.20% of cases, suggesting meticulous vessel selection can mitigate pedicle length constraints. The ALT remained the workhorse (90% of cases) due to its consistent anatomy and chimeric potential.

A systematic algorithm optimizes outcomes. While ALT is the primary choice , alternative thigh flaps are essential backups. Surgical planning must prioritize recurrence status, as it significantly increases the risk of flap failure.

Management of neck in oral cavity squamous cell cancer
(OCSCC) has been well established in the previous literature, so
far. However, controversy exists regarding prophylactic neck
management of contralateral clinically node-negative (cN0) OCSCC
between the guidelines and scientific articles. We aimed to unveil and
discuss these controversies and propose potential avenues for resolution.
Data Sources: PubMed, Scopus, Web of Science and Clinicaltrials.gov.

A systematic review of literature was performed using the
preferred reporting items for systematic reviews and meta-analyses
(PRISMA) guidelines. Data sources were searched for papers published
up to July 2025. Methodological index for non-randomized studies
(MINORS) was used for quality assessment of the included studies.

Twenty-four articles, met the inclusion criteria with a total
sample size of 5148 patients. Eight studies assessed the risk factors of
contralateral invasion, 5 investigated the strategies for neck management
in contralateral N0 OCSCC and 11 discussed both.

Contralateral elective neck dissection is the more commonly
recommended approach in the current literature for patients with
significant risk factors including tumors tongue or floor of mouth, midline
reaching/crossing, DOI above 10mm, ENE, ipsilateral N+ and stage T3 or
T4. However, 'watchful waiting' is the preferred approach for specific
patients, particularly in well-lateralized cases. A personalized,
multidisciplinary approach is required to optimize patient outcomes.
Further prospective and randomized controlled trials (Level of Evidence III) are highly recommended for the resolution of the controversies and
establishment of optimal strategies for management of the contralateral
neck in patients with contralateral cN0 OCSCC.

Post-traumatic infections are a feared complication in the management of midfacial fractures; however, it remains unclear whether routine antibiotic prophylaxis is necessary to prevent such infections. This study aimed to evaluate the impact of omitting antibiotic prophylaxis on post-traumatic infection rates in patients with midfacial fractures treated at the Thurgau Hospital Group.

A retrospective cohort study was conducted including all patients treated for midfacial fractures in two distinct years: 2023, during which prophylactic antibiotics were routinely administered, and 2024, when antibiotic prophylaxis was omitted. Included were all midfacial fractures, encompassing the sinus frontalis, sinus maxillaris, cellulae ethmoidales, and sinus sphenoidalis, regardless of whether treatment was operative or conservative. Patient demographics, including age and sex, were recorded. The primary outcome was the incidence of post-traumatic infections.

A total of 52 patients were included for 2023 and 59 patients for 2024. The mean age was 60 years in 2023 and 62 years in 2024. In 2023, 61% of patients were male, compared to 62% in 2024. No post-traumatic infections were observed in either cohort.

The absence of post-traumatic infections in both groups suggests that omitting antibiotic prophylaxis in the management of midfacial fractures does not increase infection risk. These findings support reconsidering the routine use of antibiotic prophylaxis in such cases and contribute to improved antibiotic stewardship. Further prospective studies are warranted to confirm these results.

The nasal subunit of the soft triangle is an area known for its unique reconstructive challenges due to its complex anatomical structure coupled with its critical aesthetic and functional roles. The aim of this paper is to present the armamentarium of techniques used to reconstruct the soft triangle and to provide the clinician with indications, pitfalls, and an algorithm for their use.

The systematic review was performed using PRISMA guidelines to evaluate techniques for soft triangle reconstruction and help guide surgeons for their best-fit reconstruction based on the size and composition of the defect they are faced with. A literature search was conducted to include the databases of MEDLINE via OVID, EMBASE, CINAHL, PubMed, and Cochrane central registry of trials.

In the review, 13 studies were selected, encompassing 900 patients with differing defects ranging from 0.6 to 5.5 cm in size. Our study outlines complication rates experienced, revision rate, and surgeon vs patient outcome measures where they are reported. We have found that while composite grafts are effective for smaller defects, they experience a high number of complication rates, and therefore, for larger defects, we recommend using vascularised interpolated flaps with cartilage support grafts.

This review underscores the importance of tailored approaches, anatomical understanding, and patient-centered decision making. Future research should prioritize comparative studies and standardized evaluation metrics to enhance evidence-based guidelines.