Complex midface reconstruction: maximizing contour and bone graft survival utilizing periosteal free flaps

Midfacial bone and soft tissue defects present a unique challenge because they require a complex arrangement of tissues in a relatively limited space. This may be difficult to achieve with free osteocutaneous flaps. The use of bone grafts allows greater flexibility in reconstruction but is limited by graft resorption. This is the report of midface reconstruction using a large iliac crest graft covered with a radial forearm free fascioperiosteal flap to augment graft survival. Histopathology and patient follow-up evaluation are presented demonstrating viable bone throughout the graft at biopsy 4 months postoperatively.