Avoiding Facial Incisions with Midface Free Tissue Transfer

Mark W. Stalder, Michael Sosin, Leo J. Urbinelli, James L. Mayo, Amir Dorafshar, Hugo St Hilaire, Daniel E. Borsuk, Eduardo D. Rodriguez

Research output: Contribution to journalArticle

Abstract

Background: We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions. Methods: Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions. Results: The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars. Conclusion: This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.

Original languageEnglish (US)
Article numbere1218
JournalPlastic and Reconstructive Surgery - Global Open
Volume5
Issue number2
DOIs
StatePublished - Feb 1 2017

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Free Tissue Flaps
Iliac Artery
Esthetics
Cicatrix
Veins
Necrosis
Arteries
Blast Injuries
Pathology
Zygoma
Mucoepidermoid Carcinoma
Cocaine-Related Disorders
Fibula
Quadriceps Muscle
Forearm
Dissection
Morbidity
Muscles
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

Stalder, M. W., Sosin, M., Urbinelli, L. J., Mayo, J. L., Dorafshar, A., Hilaire, H. S., ... Rodriguez, E. D. (2017). Avoiding Facial Incisions with Midface Free Tissue Transfer. Plastic and Reconstructive Surgery - Global Open, 5(2), [e1218]. https://doi.org/10.1097/GOX.0000000000001218

Avoiding Facial Incisions with Midface Free Tissue Transfer. / Stalder, Mark W.; Sosin, Michael; Urbinelli, Leo J.; Mayo, James L.; Dorafshar, Amir; Hilaire, Hugo St; Borsuk, Daniel E.; Rodriguez, Eduardo D.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 5, No. 2, e1218, 01.02.2017.

Research output: Contribution to journalArticle

Stalder, MW, Sosin, M, Urbinelli, LJ, Mayo, JL, Dorafshar, A, Hilaire, HS, Borsuk, DE & Rodriguez, ED 2017, 'Avoiding Facial Incisions with Midface Free Tissue Transfer', Plastic and Reconstructive Surgery - Global Open, vol. 5, no. 2, e1218. https://doi.org/10.1097/GOX.0000000000001218
Stalder MW, Sosin M, Urbinelli LJ, Mayo JL, Dorafshar A, Hilaire HS et al. Avoiding Facial Incisions with Midface Free Tissue Transfer. Plastic and Reconstructive Surgery - Global Open. 2017 Feb 1;5(2). e1218. https://doi.org/10.1097/GOX.0000000000001218
Stalder, Mark W. ; Sosin, Michael ; Urbinelli, Leo J. ; Mayo, James L. ; Dorafshar, Amir ; Hilaire, Hugo St ; Borsuk, Daniel E. ; Rodriguez, Eduardo D. / Avoiding Facial Incisions with Midface Free Tissue Transfer. In: Plastic and Reconstructive Surgery - Global Open. 2017 ; Vol. 5, No. 2.
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