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Ron J. Karni

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Review Jul 2026

Head and Neck Free Flap Reconstruction: Current Landscape and Emerging Technologies.

OBJECTIVE To synthesize contemporary developments in head and neck oncologic free flap reconstruction, with emphasis on perioperative physiologic optimization, digital integration, and functional recovery. DATA SOURCES MEDLINE (PubMed), Scopus, and Embase were searched for English-language human studies published between January 2020 and November 2025. Reference lists of relevant systematic reviews, consensus guidelines, and high-impact primary studies were manually reviewed to identify additional sources. REVIEW METHODS This structured state-of-the-art narrative review examined contemporary conceptual, physiologic, and technological developments rather than pooled quantitative outcomes. Priority was given to systematic reviews, consensus statements, randomized or quasi-experimental ERAS studies, high-volume cohort analyses, and translational research with direct relevance to oncologic free flap reconstruction. Evidence was synthesized thematically across perioperative optimization, intraoperative physiology, reconstructive strategy, salvage reconstruction, digital and artificial intelligence-enabled tools, and functional and survivorship outcomes. Studies limited to benign disease, trauma, pediatric populations, or isolated technical descriptions without perioperative or oncologic context were excluded. CONCLUSIONS Contemporary head and neck free flap reconstruction has evolved toward a more integrated, systems-oriented model that extends beyond technical reliability. ERAS pathways, frailty-informed assessment, refined intraoperative physiology, and contemporary salvage strategies have informed perioperative management in complex patient populations. Digital planning and emerging computational tools have improved precision and workflow efficiency in selected settings, although many applications remain investigational. Functional outcomes have also gained prominence as important measures of reconstructive success. IMPLICATIONS FOR PRACTICE Optimal outcomes depend on coordinated perioperative pathways, patient-specific physiologic optimization, judicious intraoperative management, and structured assessment of functional recovery and survivorship.

Sholem Hack, Eric Remer, E. Alon et al. · 0 citations
Open access Feb 2026

The AI-educated patient

Patients increasingly consult generative artificial intelligence (GenAI) tools before and after clinical encounters. We argue this represents a qualitative shift beyond the “Dr. Google” era: large language models (LLMs) synthesise information into coherent, guideline-framed narratives that may raise the baseline knowledge patients bring to consultations. We introduce the concept of the “AI-educated patient” and a related conceptual framework, “soft accountability”, describing the informal pressure that may arise when well-informed patients enter consultations with structured expectations. We discuss potential mechanisms by which AI-mediated patient education could influence clinician behaviour, while framing these explicitly as hypotheses awaiting empirical testing. Substantial risks remain, including hallucinations, false patient confidence, inequities in AI access and literacy, clinician workload implications, and privacy concerns. The opportunity and challenge is to harness this shift equitably for both sides of the clinical relationship.

Sholem Hack, Rebecca Attal, Ron J. Karni · 0 citations