Revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients

This study reviews the author's experience with revascularized tissue transfer for the repair of complex midfacial defects in oncologic patients.

Fifteen oncologic patients who had received vascularized tissue repair of combined skeletal and soft tissue defects during 1991 to 1999 were reviewed. The mean postoperative interval was 50.2 months. Primary reconstruction was accomplished by vascularized soft tissue repair alone in 1 case, an osteocutaneous scapula graft in 1 case, and by vascularized soft tissue and nonvascularized bone grafts in 3 cases. Secondary reconstruction with nonvascularized bone after vascularized soft tissue transfer was done in 3 cases, and vascularized secondary reconstructions with composite flaps were performed in the remaining 7 cases. Patients were examined for closure of oronasal or oroantral perforations and restoration of midfacial contour. The results were categorized as good, fair, and poor, and were related to the type and timing of the restoration.

One flap loss was encountered and one compromised flap was salvaged. Secondary nonvascularized skeletal reconstructions after vascularized soft tissue transfer were susceptible to infectious complications caused by voids, and they did not provide adequate skeletal contour in higher-order defects. Contour restoration was estimated to be good in 9 patients, fair in 3, and poor in 3. Poor results were limited to secondary reconstructions.

It is concluded that the skeletal repair of the midface frame should be done primarily, as far as possible. If the orbital frame can be preserved, primary repair by vascularized soft tissue alone may be sufficient, with secondary restoration of the alveolar crest with nonvascularized bone grafts. Complex midfacial defects of types IV and V according to Wells and Luce require multistep procedures to accomplish all goals of midfacial reconstruction.