3-DIMENSIONAL FOLDED FREE-FLAP RECONSTRUCTION OF COMPLEX FACIAL DEFECTS USING INTRAOPERATIVE MODELING

Free-tissue transfer has emerged as the ideal way of reconstructing co mplex facial defects. Multifaceted free flaps are often needed, and we have developed a simple technique to determine both the volume of tis sue required and the localization of the various epithelial surfaces, thereby simplifying these complex reconstructions. We report our exper ience in reconstructing 19 complex facial defects in which we have use d an intraoperative alginate moulage that has provided an accurate thr ee-dimensional model of the defect, helping to determine the volume of the flap required. The reconstruction was further simplified by conve rting this three-dimensional model into a two-dimensional pattern by w rapping the model with a piece of Esmarch bandage, thereby determining the locations and sizes of the epithelial surfaces. The pattern was t hen transferred to the donor site and the flap deepithelialized and th inned in situ with complete confidence that the tissue was ''tailor-ma de'' for the defect.