Three-dimensional folded free-flap reconstruction of complex facial defects using intraoperative modeling

Free-tissue transfer has emerged as the ideal way of reconstructing complex facial defects. Multifaceted free flaps are often needed, and we have developed a simple technique to determine both the volume of tissue required and the localization of the various epithelial surfaces, thereby simplifying these complex reconstructions. We report our experience in reconstructing 19 complex facial defects in which we have used an intraoperative alginate moulage that has provided an accurate three-dimensional model of the defect, helping to determine the volume of the flap required. The reconstruction was further simplified by converting this three-dimensional model into a two-dimensional pattern by wrapping the model with a piece of Esmarch bandage, thereby determining the locations and sizes of the epithelial surfaces. The pattern was then transferred to the donor site and the flap de-epithelialized and thinned in situ with complete confidence that the tissue was "tailor-made" for the defect.