The evolution of critical concepts in aesthetic craniofacial microsurgical reconstruction
Plastic and Reconstructive Surgery, 04/13/2012
Fisher M et al. – To achieve aesthetically pleasing results in free flap facial reconstruction, authors define seven critical concepts to guide the reconstruction: aesthetic unit appearance, defect boundaries, tissue requirements, vascularized skeletal buttress framework, ample soft tissue volume, early reconstruction, and local revisional procedures.Methods
- Authors assembled a two–center, retrospective cohort review of patients who underwent free tissue transfer of craniofacial defects at the R Adams Cowley Shock Trauma Center and the Johns Hopkins Hospital from 2003 to 2011.
- Patients were categorized by anatomic location, complications recorded, and illustrative cases selected.
- 184 patients with craniofacial defects were identified; 79 females and 105 males, with a mean age of 44 years.
- Etiologies included cancer (51.6%), trauma (39.1%), congenital defects (6.5%), and infection (2.7%). Free tissue transfers included 67 fibula, 42 anterolateral thigh, 41 ulnar, 18 groin, 14 iliac, 3 radius, and 1 vastus lateralis flaps.
- The success rate was 97.3% and complication rate was 10.8%.
- Secondary procedures included suction lipectomy, dermabrasion, tissue re–suspension, and cutaneous flap excision followed by full thickness skin grafting or tissue rearrangement.