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Microsurgical reconstruction of the midface
R D Foster1, J P Anthony, M I Singer
1Division of Plastic and Reconstructive Surgery, University of California at San Francisco, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|September 1, 1996
Summary
Free-flap reconstruction effectively restores function and appearance in complex midfacial defects. The fibula osteocutaneous flap is preferred for reconstructions requiring osseointegrated implants, such as the alveolar ridge or orbit.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Oral and Maxillofacial Surgery
Background:
- Complex midfacial defects often result from neoplasm or trauma.
- Reconstruction aims to restore both aesthetic and functional outcomes.
Purpose of the Study:
- To establish a treatment algorithm for reconstructing complex midfacial defects.
- To evaluate the efficacy of free-flap transfer in midfacial reconstruction.
Main Methods:
- Retrospective case series of 31 patients treated between 1991 and 1995.
- Reconstruction utilized one of four free flaps: rectus abdominis, radial forearm, fibula, or latissimus dorsi.
- Outcomes assessed via patient questionnaires and physical examinations, including aesthetic and functional results, morbidity, and recurrence.
Main Results:
- High success rate with 87% of patients undergoing single-procedure reconstruction.
- All flaps survived with an average postoperative hospital stay of 14 days.
- Good or excellent aesthetic (77%) and functional (87%) results were achieved; 23% experienced tumor recurrence.
- 80% of patients with alveolar ridge resection received dental rehabilitation, with 44% receiving osseointegrated implants.
Conclusions:
- Free-flap transfer is a successful method for reconstructing complex midfacial defects, restoring both appearance and function.
- Bone reconstruction, specifically the fibula osteocutaneous free flap, is indicated for areas requiring osseointegrated implants (alveolar ridge, orbit).
- Soft-tissue flaps are suitable for other midfacial reconstructions based on wound size.