Technical issues in the high-risk patient

Lateral craniofacial resections and reconstructions are typically long and complex surgeries. Patient selection is important in planning the most appropriate reconstruction. In addition to medically optimizing patients with significant comorbidities, the preoperative work-up should include planning for locating adequate free flap recipient blood vessels. Appropriate flap selection and design are critical not only to optimize functional and aesthetic outcomes but to minimize the risk for complications such as cerebrospinal fluid leak, fistulae, and flap loss.