Conclusions

Although advances in free-flap reconstruction have eclipsed the popularity of the IHF, it remains a useful and highly reliable tool for head and neck reconstruction. One reason is that surgical refinements continue to expand the versatility of the IHF. This review provides surgeons with a comprehensive overview of modified IHF techniques. Failures of the IHF are primarily related to skin-flap necrosis because of the unique venous drainage system of the skin paddle. Thus, most modifications have focused on increasing flap viability by improving venous return. This review also highlights that comparisons between techniques and long-term outcomes remain limited in the literature. Further comparative studies are needed to identify the optimal modification for IHF reconstruction.