THE SANDWICH EPICRANIAL FLAPS

Sandwich epicranial flaps are prefabricated composite flaps that have multiple uses in reconstructing the middle and the lower facial region . Sandwich epicranial flaps always comprise the galea and a full-thick ness skin graft; they may, in addition, include the temporal muscle an d a fragment of parietal bone. According to their composition, four ty pes of sandwich epicranial flaps are described. Experience with a use of 36 sandwich epicranial flaps (13 with vascularized bone) is reporte d. A few examples demonstrate the use of sandwich epicranial flaps in dramatic facial mutilation following noma in children. The sandwich ep icranial flap can be performed at any age, does not require microsurgi cal anastomoses, and has a low complication rate. It is particularly u seful for major reconstructive procedures in children.