title: Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.
abstract: BACKGROUND
  Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction.
  
  
  METHODS
  An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching.
  
  
  RESULTS
  Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction.
  
  
  CONCLUSIONS
  Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.
authors.affiliation: From the Division of Plastic Surgery, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Jaiswal
authors.forename: Lee L Q
authors.initials: LL
authors.lastname: Pu
mesh_terms: D000293:Adolescent; D005151:Facial Injuries / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome