Reconstructive Approach to an Acquired Absence of Multiple Facial Components: A Case Report

The subject of our case report is a young girl who was attacked by a raccoon when she was 5 months old. She lost the majority of her nose, her entire right ear, and part of her upper lip. She had previous attempts at reconstructive surgery with poor results. Our collective goals were to provide lifelong reconstruction without the use of synthetic implants and to organize the steps in a way that provided psychological benefit early on while allowing her to continue education and childhood activities with minimal disruptions. We approached the patient's many problems in stages by starting with the most obvious deformity and progressing to the least severe deformity. A radial forearm free flap and a forehead flap with rib cartilage were used in stages for nasal reconstruction. An Abbé flap was utilized for lip reconstruction, and a prelaminated radial forearm free flap with a costal cartilage frame was selected to form a new ear. She had neither lasting complications nor any morbidity from her donor sites. She and her family report a drastic improvement in her self-confidence and in her interactions with her peers. A stepwise approach to reconstruction of acquired absence of multiple facial components achieves the benefit of early positive psychological results with necessary breaks from surgery to allow her normal childhood activities and education. Judicious utilization of free flaps negates the need of synthetic implants for lifelong reconstruction.