Free-Tissue Transfer Reconstruction of Midfacial and Cranio-orbito-facial Defects
Gerry F. Funk, MD;
John F. Laurenzo, MD;
Joseph Valentino, MD;
Timothy M. McCulloch, MD;
John L. Frodel, MD;
Henry T. Hoffman, MD
Arch Otolaryngol Head Neck Surg. 1995;121(3):293-303.
Abstract
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Objective
To review our results using free-tissue transfer to reconstruct midfacial and cranio-orbito-facial defects.
Design
Case series.
Setting
The University of Iowa Hospitals and Clinics, Iowa City.
Patients
Fourteen of 21 patients had defects that resulted from ablative oncologic surgery; six had severe midfacial trauma; and one had Romberg's disease.
Interventions
Four latissimus dorsi, 11 rectus abdominis, three scapula, and four forearm free-tissue transfer flaps were used.
Main Outcome Measures
Adequate flap separation of vital structures (intracranial contents and carotid artery) from the sinonasal or oropharyngeal cavities; restoration of palatal competence, oral diet, and speech intelligibility; maxillary dental rehabilitation; aesthetic results; complications; and the patient's return to social activities outside the home after surgery.
Results
The intracranial contents (six cases) or carotid artery (four cases) were protected from sinonasal or oropharyngeal contamination by the reconstructive flap in all cases in which this was required. Functional closure of the palate with the flap or a prosthesis was possible in 12 of the 13 patients with a palatal defect; seven of these 13 patients have had full maxillary dental rehabilitation. Twenty patients take an oral diet. Sixteen patients have normal or easily understood speech. Fourteen patients engage in social activities outside the home, and eight have returned to full-time employment. No vascular flap failures occurred in this series.
Conclusions
The use of free-tissue transfer flaps is a safe and effective technique for repairing large midfacial and cranio-orbito-facial defects resulting from ablative oncologic surgery or trauma.
(Arch Otolaryngol Head Neck Surg. 1995;121:293-303)
Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, University of Iowa College of Medicine, Iowa City. Dr Valentino is now with the Division of Otolaryngology—Head and Neck Surgery, University of Kentucky, Lexington. Dr Frodel is now with the Department of Otolaryngology—Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.
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