One-stage reconstruction of massive craniofacial defect with gastroomental free flap

A large craniofacial defect resulting from a close-range shotgun blast is described. It involves the left hemimandible, the left maxilla, the hard palate with nasal support, the roof of the left orbit, and the left side of the oral lining. The defect was reconstructed using autogenous ribs for the facial skeleton. The remainder of the defect was repaired with a composite free tissue transfer of gastric wall and greater omentum on the right gastroepiploic vessels. The gastric wall was used to reconstruct the oral mucosa, the omentum was packed around the bone grafts for nourishment, and a split-thickness skin graft was placed on the outside surface. The technical aspects of the procedure are described and a two-year follow-up presented.