Critical concepts in craniofacial microsurgical reconstruction

Abstract

Author(s): Hamid Reza Fathi, Javad Rahmati, Arjang Ghahremani, Jahid Mammadov and Mahammad Davudov*

Over the last several decades, there have been numerous advances in the fields of aesthetic, craniofacial, and microsurgery. According to Fisher et al. aesthetic units are no longer "skin deep" but are recognized as being composed of both soft and hard tissue. Indeed, hard tissue must complement the soft tissue to recreate the unit. In addition, revisionary procedures have become necessary to achieve the desired result. We assembled a two-centre, retrospective cohort review of patients who underwent free-tissue transfer of craniofacial defects at the Cancer Institute (Tehran) and the Central Hospital (Baku) from 2009 to 2013. Patients were categorized by anatomic location, complications recorded, and illustrative cases selected. A total of 124 patients with craniofacial defects were identified: 39 female and 85 male patients, with a mean age of 57 years. Etiologies included cancer (95.2%), trauma (0.8%), congenital defects (1.6 %), and benign tumour (2.4%). Free-tissue transfers included 38 fibula, 6 anterolateral thigh, 19 latissimus dorsi musculocutaneous flap, 12 latissimus dorsi muscle flap, 12 osteocutaneous radial, 16 fasciocutaneous, 14 rectus abdominis musculocutaneous, 6 rectus abdominis muscle, one vastus lateralis flaps. The success rate was 96.7% and complication rate was 11.2%. Secondary procedures included fat injection, tissue resuspension, and cutaneous flap excision followed by full-thickness skin grafting or tissue rearrangement. Here, we integrate the critical concepts and provide a patient series illustrating their success.

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