Some of the greatest challenges in reconstructive surgery are defects of the head and neck. Maximizing form, function, and appearance are critical in achieving the optimal result. It is often necessary to skip layers of the typical reconstructive pyramid and use the most complex option first (Fig. 5). The introduction of free tissue transfer has provided the surgeon with the ability to restore the defect with "like" tissue and has improved our ability to achieve a more anatomic and functional result in an expedient fashion. Future advances in tissue engineering and implant technology will likely contribute to the evolution of head and neck reconstruction. By best matching the patient's needs with the reconstructive options available, the surgeon will be able to optimize the patient's result and quality of life.
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