Anesthesia and perioperative considerations for patients undergoing free tissue reconstruction of the oral cavity: a narrative review

Background and Objective: Microvascular free tissue transfer (MFTT) for reconstruction of oral cavity defects are complex and extensive surgeries that entail long procedure times, substantial blood loss, and meticulous preoperative planning in order to decrease perioperative complications and improve clinical outcomes. Many factors are important and contribute to the success of these surgeries. The purpose of this paper is to demonstrate the factors involved in perioperative management of head and neck patients undergoing MFTT of the oral cavity. Methods: An online review of scientific articles was performed using PubMed and Google Scholar to gather data from controlled trials, cohort studies, systematic reviews and meta-analyses. The search involved several keywords and their combinations including: oral cavity, free flap transfer, microvascular reconstruction of oral cavity. Articles were evaluated in a 25-year period from 1999-2024. The inclusion criteria were studies in English, literature relevant to the expert consensus, and relevance to our study. Key Content and Findings: A variety of factors are important in the perioperative management of the MFTT patient. Advancements in surgical techniques and postoperative flap monitoring have improved the success rate of oral cavity MFTT reconstruction. Furthermore, nutrition and behavioral factors remain important keys to medical optimization before MFTT. Finally, nutritional intake and pain management in the postoperative course are also important in wound healing and early mobilization. Conclusions: MFTT for oral cavity reconstruction is a complex science and requires meticulous planning and monitoring in the perioperative period to ensure free flap success rates, minimize complications, and improve clinical outcomes.