Microvascular surgery has revolutionized the management of head and ne
ck cancer. Prior to the possibility of free-tissue transfer, treatment
of advanced cutaneous cancer was limited by a lack of adequate recons
tructive methods for large surface defects. Today almost any defect ca
n be repaired. Skin, muscle, bone, or viscera can be transferred from
a distant site and reshaped to simulate missing structures or provide
a foundation for maxillofacial prostheses. This article discusses seve
ral new opportunities available for patients with advanced skin malign
ancies in the head and neck.