3-DIMENSIONAL COMBINED FLAPS FOR RECONSTRUCTION OF COMPLEX FACIAL DEFECTS FOLLOWING CANCER ABLATIONS

Instead of conventional multiple-paddle or folded free flaps, the auth ors introduce three types of free combined tissue transfers for cosmet ic and functional restoration of massively large facial defects. Three cases reported here were repaired with combined Flaps consisting of t wo or more tissues, such as combined free anterolateral thigh flaps an d vascularized muscle or bone grafts. In cases with complex defects in the upper lateral face, Facial dynamics were also reconstructed with a free vascularized innervated muscle graft. A complex hemifacial defe ct involving the orbita and nose can be easily reconstructed with free osteocutaneous flaps in two stages. For complex craniofacial defects, the concept of combined chimeric tissue transfers is most suitable. T he ideal pedicle Vessels for the combined flaps are considered to be t hose in the lateral circumflex femoral system, which is far from the h ead and neck regions, because Flap elevation can proceed simultaneousl y with tumor resection.