title: Microsurgical reconstruction of the midface.
abstract: OBJECTIVE
  To establish a treatment algorithm for reconstructing complex midfacial defects.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  University-based teaching hospital.
  
  
  METHODS
  Thirty-one consecutive patients were treated from 1991 through 1995. The 18 males and 13 females were aged 15 to 90 years (mean age, 58 years). The cause of the defect included neoplasm (n = 27) and trauma (n = 4). Reconstruction consisted of 1 of 4 free flaps: rectus abdominis, radial forearm, fibula, or latissimus dorsi. Aesthetic and functional results were determined by patient questionnaires and physical examinations.
  
  
  METHODS
  Length of stay, postoperative morbidity and mortality, degree of aesthetic and functional restoration, and detection of tumor recurrence.
  
  
  RESULTS
  Twenty-seven (87%) of the 31 patients underwent reconstruction with a single major procedure. All of the flaps survived. Postoperative hospital stays averaged 14 days. Late tumor recurrence occurred in 7 (23%) of the 31 patients and was promptly detected. Aesthetic and functional results were rated good or excellent in 77% (24/31) and 87% (27/31) of patients, respectively. Of the 20 patients who underwent alveolar ridge resection, 16 (80%) received dental rehabilitation, 44% of whom received osseointegrated implants into either a bone flap or remaining native bone. Osseointegrated implants were inset during the initial reconstruction 57% (4/7 patients) of the time.
  
  
  CONCLUSIONS
  For complex midfacial defects, free-flap transfer can be performed with a high degree of success, restoring both appearance and function in most patients. The only instance in which bone is necessary to reconstruct the midface involves those areas in which osseointegrated implants are needed, ie, alveolar ridge (dental implant) and/or orbit (ocular prosthesis). In such cases, the fibula osteocutaneous free flap is the flap of choice. Otherwise, soft-tissue flaps are selected based on wound size.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California at San Francisco, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Foster
authors.forename: J P
authors.initials: JP
authors.lastname: Anthony
authors.forename: M I
authors.initials: MI
authors.lastname: Singer
authors.forename: M J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: M A
authors.initials: MA
authors.lastname: Pogrel
authors.forename: S J
authors.initials: SJ
authors.lastname: Mathes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005151:Facial Injuries / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000379:methods*