title: Facial bone reconstruction with prefabricated vascularized calvarium flaps in children and young adults: Advantages and long-term results.
abstract: BACKGROUND
  Reconstruction of facial bone defects in children is challenging. The use of well-vascularized bone is mandatory to obtain stable lasting results. This study reports our experience of facial bone reconstruction using prefabricated vascularized calvarium flaps.
  
  
  METHODS
  Retrospective case series of 50 patients who underwent 52 maxillary, malar, and mandibular reconstructions between 1988 and 2014 using prefabricated vascularized calvarium flaps. Forty-nine patients suffered from noma sequels; one patient had craniofacial cleft Tessier 3-11. Surgery consisted of a two-step procedure beginning with flap delay and prelamination with skin grafting on the galea. Flap harvest followed at least 2 weeks later (range, 2-16 weeks), including a full-thickness calvarium fragment, which was set into the facial defect.
  
  
  RESULTS
  Early complications concerned wound healing and infections requiring surgical revision in six patients at the recipient and six at the donor site. There was one flap loss. Clinical long-term assessment at 15-year median follow-up (range, 1-27 years) showed good results, assuring facial height and contour. Radiological long-term results demonstrated excellent integration of the flap to the adjacent facial skeleton of the growing child.
  
  
  CONCLUSIONS
  Prefabricated vascularized calvarium flaps are an effective, safe and lasting method for reconstruction of facial bone defects in children.
authors.affiliation: Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. Electronic address: Eva.Ruegg@hcuge.ch.
authors.forename: Eva Meia
authors.initials: EM
authors.lastname: Rüegg
authors.affiliation: Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Gniadek
authors.affiliation: Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Modarressi
authors.affiliation: Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
authors.forename: Denise
authors.initials: D
authors.lastname: Baratti-Mayer
authors.affiliation: Division of Plastic, Reconstructive and Esthetic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Pittet-Cuénod
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005147:Facial Bones / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D012189:Retrospective Studies; D012886:Skull / Q000098:blood supply / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone flap; Bone reconstruction; Calvarium flap; Face reconstruction; Noma; Reconstruction children