Revascularized tissue transfer for the repair of complex midfacial defectsin oncologic patients

Purpose: This study reviews the author's experience with revascularized tis sue transfer for the repair of complex midfacial defects in oncologic patie nts. Patients and Methods: Fifteen oncologic patients who had received vasculari zed tissue repair of combined skeletal and soft tissue defects during 1991 to 1999 were reviewed. The mean postoperative interval was 50.2 months. Pri mary reconstruction was accomplished by vascularized soft tissue repair alo ne in 1 case, an osteocutaneous scapula graft in 1 case, and by vascularize d soft tissue and nonvascularized bone grafts in 3 cases. Secondary reconst ruction with nonvascularized bone after vascularized soft tissue transfer w as done in 3 cases, and vascularized secondary reconstructions with composi te flaps were performed in the remaining 7 cases. Patients were examined fo r closure of oronasal or oroantral perforations and restoration of midfacia l contour. The results were categorized as good, fair, and poor, and were r elated to the type and timing of the restoration. Results: One flap loss was encountered and one compromised flap was salvage d. Secondary nonvascularized skeletal reconstructions after vascularized so ft tissue transfer were susceptible to infectious complications caused by v oids, and they did not provide adequate skeletal contour in higher-order de fects. Contour restoration was estimated to be good in 9 patients, fair in 3, and poor in 3. Poor results were limited to secondary reconstructions. Conclusion: It is concluded that the skeletal repair of the midface frame s hould be done primarily, as Far as possible. If the orbital frame can be pr eserved, primary repair by vascularized soft tissue alone may be sufficient , with secondary restoration of the alveolar crest with nonvascularized bon e grafts. Complex midfacial defects of types IV and V according to Wells an d Luce require multistep procedures to accomplish all goals of midfacial re construction. (C) 2000 American Association of Oral and Maxillofacial Surge ons.