Semin Plast Surg 2003; 17(3): 291-304
DOI: 10.1055/s-2004-815687
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Reconstruction of the Midface with Vascularized Bone and Soft Tissue

John J. Coleman, III
  • Indiana University School of Medicine and Richard Roudebush Veterans Administration Medical Center, Indianapolis, IN
Further Information

Publication History

Publication Date:
23 January 2004 (online)

ABSTRACT

Because of its anatomical location and complexity, the midface has been a challenging area to approach with reconstructive techniques. Its three-dimensional nature and importance in the functions of alimentation and respiration make the reconstruction of the midface imperative to survival and quality of life. Previously used methods relied primarily on prosthetic devices and local flaps, which were frequently inadequate. Thoracic musculocutaneous flaps are limited in their arcs of rotation and are of only moderate value in this area. Microvascular free tissue transfer has greatly improved results in both appearance and function. Three-dimensional manipulation of osteocutaneous flaps, such as the radial forearm and the scapula, or soft tissue flaps, such as latissimus dorsi, rectus abdominis, omentum and scapula, can be employed to satisfy almost any defect. The nature of the defect analyzed as either contour or complex three-dimensional, with other factors, will determine which flap is most useful.

REFERENCES

  • 1 Coleman J J. Microvascular approach to function and appearance of large orbito-maxillary defects.  Am J Surg . 1989;  158 337-341
  • 2 Manson P N, Hoopes J E, Su C T. Structural pillars of the facial skeleton: an approach to the management of Le fort fractures.  Plast Reconstr Surg . 1980;  66 54-62
  • 3 Gruss J S, VanWyck L, Phillips J H, Antonyshyn O. The importance of the zygomatic arch in complex midfacial fracture repair and correction of post-traumatic orbito-zygomatic deformities.  Plast Reconstr Surg . 1990;  85 878-890
  • 4 Yousif N J, Mendelson B C. Anatomy of the midface.  Clin Plast Surg . 1995;  22 227-240
  • 5 Wilkes G H, Wolfardt J F. Prosthetic Reconstruction. In: Achauer BM, ed. Plastic Surgery: Indications, Operations, Outcomes, Vol 3 St. Louis, Mosby; 2000: 1583-1609
  • 6 Brown R H, Nahai F, Silverton J S. The Omentum in Facial Reconstruction.  Br J Plast Surg . 1978;  31 58-62
  • 7 Cole R D, Browne J D, Phipps C D. Gunshot wounds. The mandible and midface: Evaluation, treatment and avoidance of complications.  Otolaryngol Head Neck Surg . 1994;  111 739-745
  • 8 Coleman J J. Midface Reconstruction. In: Achauer BM, ed. Plastic Surgery: Indications, Operations, Outcomes, Vol 3 St. Louis, Mosby; 2000: 1409-1424
  • 9 Coleman J J, Sultan M K. The Bipedicle osteocutaneous scapula flap: a new subscapula system free flap.  Plast Reconstr Surg . 1991;  87 682-692
  • 10 Konno A, Toqawa K, Iizuka K. Primary reconstruction after total or extended total maxillectomy for maxillary cancer.  Plast Reconstr Surg . 1981;  67 440-448
  • 11 Antonyshyn O M, Paletz J L, Wilson K L. Reconstruction of composite facial defects: the combined application of multiple reconstructive modalities.  Can J Surg . 1993;  36 441-452
  • 12 Lemon J C, Chambers M S, Wesley P J, Reece G P, Martin J W. Rehabilitation of a midface defect with reconstructive surgery and facial prosthetics: a case report.  Int J Oral Maxillofac Implants . 1996;  11 101-105