RECONSTRUCTION OF COMPOSITE FACIAL DEFECTS - THE COMBINED APPLICATIONOF MULTIPLE RECONSTRUCTIVE MODALITIES

Objective: To describe the combined use of craniofacial skeletal recon struction, tissue expansion and microvascular free tissue transfer in the repair of major composite facial defects. Design: Case series with an integrated team approach. Setting. Craniofacial unit, university t eaching hospital. Patients: Three cases were selected to best illustra te the combined use of the three modalities in reconstruction of acute traumatic, congenital and post-traumatic facial defects. A 15-year-ol d boy had a shotgun wound to the face; a 23-year-old man had Treacher Collins syndrome; and a 55-year-old woman had a post-traumatic composi te defect of the central midface. Interventions: Preoperatively, compl ete neurologic, ophthalmologic and dental examinations, anthropometric analysis, prosthodontic assessment, computed tomography and computer graphics. Operatively, craniofacial exposure followed established surg ical principles. Skeletal reconstruction was performed to provide accu rate positioning of bony segments and three-dimensional stability. Bon e grafting was used when necessary to restore bony continuity and incr ease stability. Tissue expansion was used to provide more locally avai lable tissue for wound closure and resurfacing composite defects. Micr osurgical free tissue transfer was used to provide functional replacem ent of deficient tissues. Results: The results of the modalities used for reconstruction of these composite facial defects are illustrated f or each case described. Conclusions: The use of multiple modalities, i ncluding craniofacial skeletal reconstruction, tissue expansion and fr ee tissue transfer, allow the surgeon to address the specific function al and anatomical requirements associated with composite facial defect s that are characterized by a combined deficiency of multiple tissues in the craniofacial region.