Total face reconstruction with one expanded free flap

Deformities of a totally burned face present a profound challenge to the reconstructive plastic surgeon. Skin grafting has been used traditionally for resurfacing with limited success, especially when the burns were so severe the deeper structures were destroyed. Total face reconstruction, using bilateral extended scapular free flap, has been reported previously for severe deformities following an extensive facial burn. Although this method obtained better aesthetic and functional results than skin grafting, the donor-site morbidity was relatively high, with a large scar that extended across the entire back. In addition, the nose needed to be reconstructed separately with a forehead flap or free radial forearm flap. The authors experienced a case in which a totally burned face was reconstructed successfully with a single free-expanded flap. A 54-year-old man sustained a severe facial burn with gasoline that involved the face, anterior neck, anterior chest, and bilateral upper extremities. Sequential debridement and skin grafting were required to close the burn wound. A tissue expander was inserted in his left back before the facial reconstruction. Six months after insertion of the tissue expander, the left dorsal skin was transferred to the face as one large flap, size 28x27 cm, with three sets of vascular anastomoses. The flap totally survived with abundant tissue at the central area to reconstruct the nose. With five complementary procedures, including a costal cartridge graft, the shape of the nose was restored, and acceptable functional and aesthetic results were obtained. This method did not require a separate tissue transfer for nasal reconstruction. To our knowledge, this is the first case of successful reconstruction with one flap for total face reconstruction that included the nose.