MICROSURGICAL RECONSTRUCTION OF THE MIDFACE

Objective: To establish a treatment algorithm for reconstructing compl ex midfacial defects. Design: Retrospective case series. Setting: Univ ersity-based teaching hospital. Patients: Thirty-one consecutive patie nts were treated from 1991 through 1995. The 18 males and 13 females w ere aged 15 to 90 years (mean age, 58 years). The cause of the defect included neoplasm (n=27) and trauma (n=4). Reconstruction consisted of 1 of 4 free flaps: rectus abdominis, radial forearm, fibula, or latis simus dorsi. Aesthetic and functional results were determined by patie nt questionnaires and physical examinations. Main Outcome Measures: Le ngth of stay, postoperative morbidity and mortality, degree of aesthet ic and functional restoration, and detection of tumor recurrence. Resu lts: Twenty-seven (87%) of the 31 patients underwent reconstruction wi th a single major procedure. All of the flaps survived. Postoperative hospital stays averaged 14 days. Late tumor recurrence occurred in 7 ( 23%) of the 31 patients and was promptly detected. Aesthetic and funct ional results were rated good or excellent. in 77% (24/31) and 87% (27 /31) of patients, respectively. Of the 20 patients who underwent. alve olar ridge resection, 16 (80%) received dental rehabilitation, 44% of whom received osseointegrated implants into either a bone flap or rema ining native bone. Osseointegrated implants were inset during the init ial reconstruction 57% (4/7 patients) of the time. Conclusions: For co mplex midfacial defects, free-flap transfer can be performed with a hi gh degree of success, restoring both appearance and function in most p atients. The only instance in which bone is necessary to reconstruct t he midface involves those areas in which osseointegrated implants are needed, ie, alveolar ridge (dental implant) and/or orbit (ocular prost hesis). In such cases, the fibula osteocutaneous free flap is the flap of choice. Otherwise, soft-tissue flaps are selected based on wound s ize.