Microvascular free flaps (MFF) can be used in different types of OMFS reconstruction, such as for trauma-related defects and after resection of malformations, in addition to benign or malignant neoplasia (Futran et al., 2005; Zemann et al., 2011; Mitsimponas et al., 2014). In this context, oral squamous cell carcinoma represents one of the most common reasons for MFF in OMFS, with over 35 000 estimated new cases in the USA in 2020 (Uddin et al., 2022).

In compromised situations, such as a vessel-depleted neck, which can frequently be found after extended preliminary surgery and/or radio-/chemotherapy, an extracorporeal perfusion system can be used to provide the free flap with blood, oxygen, and nutrients (Fichter et al., 2016; Wolff et al., 2016, 2020). In these cases, pedicled flaps represent a suitable alternative to MFF and are still of significant relevance – for example, after free flap failure or given a lack of connection vessels (Avery et al., 2014).

Kansy et al. showed that, in Europe and worldwide, 9% and 40% of the hospitals, respectively, did not have access to MFF, most commonly due to insufficient training in this field (Kansy et al., 2015). Structured data regarding free-flap harvest and management may allow us to determine possible differences between regions and healthcare providers, but the available literature is not up to date (Kansy et al., 2015; Mücke et al., 2011). Recent factors, such as the COVID-19 pandemic or the rising use of CAD/CAM-techniques, should also be taken into account. There is some literature about the possible implications for MFF of the new challenges presented by COVID-19 (Kanatas et al., 2020; Morales-Perez et al., 2021).

Overall, the use of MFF can provide a flap survival rate of more than 95% in the head and neck region (Kesting et al., 2011; Kim et al., 2020). Possible risk factors for MFF failure are long operation times and preoperative chemotherapy (Wong et al., 2015; Wang et al., 2020). In recent years, there has been an increase in the use of MFF, such as fibula free flap, as well as newer techniques, including CAD/CAM (computer-aided design/computer-aided manufacture) procedures for creating patient-specific implants (PSI) or surgical guides (Okay et al., 2016). CAD/CAM can help to reduce operation time and to significantly increase the precision of bony reconstructions (Jehn et al., 2020; Mahendru et al., 2020; Zeller et al., 2020). Thus, OMF surgeons can be considered pioneers in 3D planning and CAD/CAM procedures for microvascular reconstructions.

Mücke et al. performed a study concerning the use and management of MFF, including OMF surgeons in Germany, Austria, and Switzerland (Mücke et al., 2011). Kansy et al. performed a study including OMFS departments in Europe, and found significant differences concerning the perioperative management (Kansy et al., 2014). Extending the survey globally, the results revealed different approaches to osteosyntheses, medication, and flap monitoring. Next, with respect to epidemiological aspects, the survey demonstrated that only half of the hospitals worldwide had access to MFF reconstructions (Kansy et al., 2015).

These data have not been updated in the last 10 years. Therefore, there is a need to update the relevant data concerning this topic and to investigate the changes arising from the COVID-19 pandemic and the use of newer technologies. This will allow more specific and effective healthcare provision.

The aim of this study was to evaluate the use of MFF and the underlying surgical procedures regarding microvascular reconstructions in OMFS departments in Germany, Austria, and Switzerland, including parameters relating to COVID-19 and CAD/CAM technologies.