Reconstruction of Midfacial Defect Using Various Free Flap.

Cho, Jae Hyun; Lee, Won Jai; Lew, Dae Hyun; Rah, Dong Kun; Tark, Kwan Chul

Original Article

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2006;33(3):283-288.
Published online May 1, 2006.

Reconstruction of Midfacial Defect Using Various Free Flap.

Jae Hyun Cho, Won Jai Lee, Dae Hyun Lew, Dong Kun Rah, Kwan Chul Tark

Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea. pswjlee@yumc.yonsei.ac.kr

Abstract

Various vascularized free flaps have been used for midfacial reconstruction after ablative head and neck cancer surgery. The most common donor sites for free flap include latissimus dorsi, rectus abdominis, and radial forearm. Between 1994 and 2004, 14 patients underwent free flap operation after head and neck cancer ablation, and were reviewed retrospectively. Among 14 free flaps, 8 were latissimus dorsi myocutaneous flaps, 3 rectus abdominis myocutaneous flaps and 3 radial forearm flaps, respectively. The overall survival rate of the flap was 100%. Complications were wound dehiscence(5 cases) and ptosis(1 case). We designed multiple dimensionally folded free flap for midfacial reconstruction. For 3-dimensional flap needs, we used latissimus dorsi myocutaneous flap. 2-Dimensional flap was latissimus dorsi or rectus abdominis myocutaneous flap and 1-dimensional flap was radial forearm flap. In this study we produced an algorithm for midfacial reconstruction. Large volume with many skin paddle defects were best reconstructed with latissimus dorsi myocutaneous flap or rectus abdominis myocutaneous flap. Radial forearm flap was used for reconstruction of small volume and little skin paddle defects.

Keywords: Free flap; Midfacial reconstruction