Evolution of midface microvascular reconstruction: A three decade
experience from a single institution
Abstract
Objectives: Midface reconstruction poses a complex set of challenges for
reconstructive surgeons. The optimal midface reconstruction must possess
a durable underlying bone construct capable of integrating dental
implants. Facial contour is restored by the overlying microvascular soft
tissue reconstruction with reestablishment of the oral cavity. A
plethora of microvascular flaps used in clinical practice have been
described including those harvested from the iliac crest, scapula,
fibula, forearm and back (latissimus dorsi). The objective was to share
our experiences with each of these treatment options that have continued
to evolve over time for the benefit of patients. Design: Our institution
has over three decades of experience in reconstructing complex midface
defects and this article summarizes midface reconstruction from an
evolutionary perspective (for type II, III and IV defect; Browns
classification, Supplementary table 1). We broadly divide this into (i)
flaps supplied by the subscapular system (ii) autologous reconstruction
with titanium mesh and (iii) fibula microvascular flaps using 3D
planning. The advantages and disadvantages for each approach are
discussed (Supplementary Table 2). Conclusion: In the future, it is
expected that 3D planning coupled with rapid prototyping, intraoperative
navigation and CT imaging will become standard procedural practice. Our
institution has over three decades of experience in reconstructing
complex midface defects and this article summarizes midface
reconstruction from an evolutionary perspective (for type II, III and IV
defect; Browns classification, Supplementary table 1). We broadly divide
this into (i) flaps supplied by the subscapular system (ii) autologous
reconstruction with titanium mesh and (iii) fibula microvascular flaps
using 3D planning. The advantages and disadvantages for each approach
are discussed (Supplementary Table 2). In the future, it is expected
that 3D planning coupled with rapid prototyping, intraoperative
navigation and CT imaging will become standard procedural practice.