Mm. Guler et al., 3-DIMENSIONAL RECONSTRUCTION OF TYPE-IV AND TYPE-V MIDFACIAL DEFECTS BY FREE RECTUS-ABDOMINIS MYOCUTANEOUS (RAM) FLAP, Microsurgery, 18(3), 1998, pp. 148-151
Extensive midfacial defects after ablative surgery constitutes a chall
enging problem for reconstructive surgeons. Particularly for types IV
and V midfacial defects, provision of missing bony support and obliter
ation of the maxillary cavity defects require microsurgical free tissu
e transfers. In the last three years, four patients have undergone tot
al maxillectomy for midfacial tumours and the postmaxillectomy defects
were three-dimensionally repaired with free rectus abdominis muscle f
lap and skin graft or myocutaneous flaps. Obliteration of maxillary ca
vity defects and orbital support were achieved with this type of free
flap. The least follow-up period of the patients is one year and sligh
t ectropion, later corrected, was seen in two patients. In this study,
the free rectus abdominis myocutaneous (RAM) flap, with its long vasc
ular pedicle and availability of various skin paddle designs and muscl
e bulk, is presented in treatment of extensive midfacial defects. In s
pite of initial overcorrection of contour, the denervated rectus abdom
inis muscle gradually atrophies, resulting in loss of contour. The mus
cle bulk fills the cavity defect, but, in order to achieve good facial
contour, it is necessary to support the bony skeleton with some mater
ial. (C) 1998 Wiley-Liss, Inc.