Challenges in midface reconstruction

Defects of the midface and maxilla are often the most challenging problems faced by the reconstructive surgeon. Resections that involve critical struc tures of the face such as the nose, eyelids, and lips in conjunction with t he maxilla can be particularly difficult to reconstruct. The algorithm for reconstruction of these defects is usually based on the extent of maxilla t hat is resected. A classification system for maxillectomy defects is the mo st useful way to approach these reconstructions. A vast majority of extensi ve defects involving the maxilla and midface require free flap reconstructi ons. The type of flap selected is based on the extent of skin, soft tissue, and bone that is resected. Smaller volume defects with large skin surface requirements are best reconstructed with the radial forearm fasciocutaneous or osteocutaneous flaps. Larger soft-tissue volume and skin surface can be provided by the rectus abdominus myocutaneous flap. Critical structures su ch as lips, eyelids, and nose should be reconstructed separately, using loc al flaps if at all possible. The free tissue transfer should ideally not be incorporated into these structures. Most patients with even the largest re sections can be restored to fairly good function by following this algorith m. Semin. Surg. Oncol. 19:218-225, 2000. (C) 2000 Wiley-Liss, Inc.