title: Extensive and complex defects of the scalp, middle third of the face, and palate: the role of microsurgical reconstruction.
abstract: Twenty-one patients with gigantic defects of the scalp and middle third of the face and palate following excision of neglected or recurrent tumors, burns, and infections have undergone microsurgical reconstruction. Wide resection of the middle third of the face, orbit, and palate requires "complex" three-dimensional volume reconstruction, whereas extensive defects of the scalp and skull (exceeding 80 cm2) require coverage of the larger surface area soft-tissue defect and the exposed brain and dura. The latissimus dorsi free-muscle flap and split-thickness skin graft have become our methods of choice for extensive scalp and skull defects. The latissimus dorsi musculocutaneous free flap is preferable for reconstruction of complex palatal and external skin and orbital defects of the middle third of the face. Microsurgical free-tissue transfer reliably frees the oncologic surgeon from the constraints imposed by conventional reconstructive techniques and may therefore allow improved curative or at least palliative resection of these extensive tumors.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of Pittsburgh School of Medicine, Pa.
authors.forename: N F
authors.initials: NF
authors.lastname: Jones
authors.forename: R A
authors.initials: RA
authors.lastname: Hardesty
authors.forename: W M
authors.initials: WM
authors.lastname: Swartz
authors.forename: S S
authors.initials: SS
authors.lastname: Ramasastry
authors.forename: F R
authors.initials: FR
authors.lastname: Heckler
authors.forename: E D
authors.initials: ED
authors.lastname: Newton
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D010157:Palatal Neoplasms / Q000601:surgery*; D012535:Scalp / Q000601:surgery*; D012878:Skin Neoplasms / Q000601:surgery*; D012888:Skull Neoplasms / Q000601:surgery*; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps