deltopectoral flap is beneficial for reconstruction of significant cheek defects, offering up to 250 cm2 of transferable cutaneous tissue to allow reconstruction of the entire cheek. The deltopectoral flap tolerates folding very well and allows movement in wide directions. Free flaps Thanks to further refinements of microvascular techniques in the past three decades, transfer of a free flap is now a routine procedure. Free flaps are the first choice in case of complex, composite, and through-through cheek defects with exposed bone, sinuses, orbit or dura. Advantages of free flaps are their reliable blood supply and freedom of planning. Potential disadvantages are the mismatch of colour, texture, facial shape and thickness. Whereas a multitude of free flaps are available, the radial forearm, anterolateral thigh, scapular, and lateral arm flap are most useful in cheek reconstruction. Prefabricated flaps Prefabrication of flaps opens interesting new possibilities. It is primarily used for reconstruction of complex defects where conventional techniques are not available (in burn patients where common donor sites may have been damaged or destroyed). Flap prefabrication starts with introduction of a vascular pedicle to a desired donor tissue that on its own does not possess an axial blood supply. After a period of neovascularization of at least 8 weeks, this donor tissue can then be transferred to the recipient defect based on the newly acquired axial vasculature. This process can be combined with the use of tissue expanders. Patient selection Careful patient selection is essential for a successful outcome. Donor site morbidity, patient characteristics such as skin laxity, age, tobacco use and sun exposure, potential radiotherapy, planned lymph node dissection, the size of the defect, structural involvement (skin, muscle, nerves, bone), functional concerns like maintaining oral hygiene, swallowing, mouth opening, aesthetic concerns, experience of the surgeon are all factors that influence the kind of reconstructive technique that should be chosen. Complications Necrosis of the flap, because of insufficient blood supply. If the blood supply of the flap is lost the flap will die. Therefore, it is very important that the surgeon must maintain the integrity of the vessels at the base of the flap to improve the survival of the flap. Possible nerve damage during the reconstructive procedure Prolonged oedema of the delicate tissues of the lower eyelid, Abnormal hair distribution in the face. Even though soft tissue defects are managed by a secondary reconstructive surgery See also Scalp reconstruction References Tissue transplants