3-DIMENSIONAL RECONSTRUCTION OF TYPE-IV AND TYPE-V MIDFACIAL DEFECTS BY FREE RECTUS-ABDOMINIS MYOCUTANEOUS (RAM) FLAP

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.