Abstract
The reconstruction of massive head and neck defects is a difficult challenge, requiring
restoration of bone, skin, and oral lining. Their complex three-dimensional nature
often dictates the need of more than a single osteocutaneous flap for intra- and extra-oral
reconstruction.
Conventional reconstructive options can be considered, but there is no single ideal
osteocutaneous free or pedicled flap providing an unlimited length of bone and skin
paddle, or that could orient the skin paddle independently of the vascularized bone.
The surgeon should then be aware of more complex options for reconstruction of extensive
three-dimensional defects, namely chimeric free flaps and “their variations.” They
can be stratified in three types, either based on their intrinsic vasculature—perforated-based,
branch-based, or whether they are prefabricated (surgical junction by microanastomosis).
Despite morbidity and not perfect matching in terms of skin texture and pliability,
these techniques are a good alternative in the presence of partial defects, especially
in the context of immediate oncological reconstruction, where facial transplantation
is not considered.
Keywords
massive defects - facial reconstruction - chimeric flaps - flow-through free flaps
