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Avoiding Facial Incisions with Midface Free Tissue Transfer.
Mark W Stalder1, Michael Sosin1, Leo J Urbinelli1
1Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, La.; Department of Plastic and Reconstructive Surgery, Johns Hopkins Medical Institute, Baltimore, Md.; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Division of Plastic Surgery, University of Montreal, Montreal, QC.
This study introduces an intraoral microsurgical technique for facial vessel anastomosis, eliminating visible facial scars in midface reconstructions. This innovative approach ensures successful free tissue transfers with excellent aesthetic outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic Surgery
- Microsurgery
Background:
- An intraoral microsurgical anastomosis to facial vessels was developed to avoid visible facial incisions.
- This technique addresses the need for scarless reconstruction in the midface.
Purpose of the Study:
- To evaluate the feasibility and outcomes of an entirely intraoral approach for free tissue transfer in midface reconstruction.
- To demonstrate the successful use of facial artery and vein as recipient vessels via an intraoral route.
Main Methods:
- Cadaveric dissection was performed to confirm intraoral access to facial vessels.
- Five patients with major midface defects underwent free tissue transfer using an intraoral, transmucosal approach.
- Reconstructions utilized various free flaps, with facial artery and vein serving as recipient vessels for microvascular anastomosis.
Main Results:
- Successful reconstruction of diverse midface defects including those from cancer, cocaine abuse, fibrous dysplasia, blast injury, and trauma.
- All five free tissue transfers were successful, with a mean follow-up of 12.2 months.
- Patients achieved satisfactory aesthetic outcomes with no visible facial scars.
Conclusions:
- The intraoral microsurgical anastomosis technique is effective for reconstructing various midface bony and soft-tissue deficits with minimal morbidity.
- This approach offers a scarless solution for midface reconstruction, improving aesthetic results.
- The study highlights the versatility of free tissue transfer using an intraoral recipient vessel approach for complex facial defects.
