Mid-face Massive Loss Reconstruction: Free Latissimus Dorsi Used as Both a Donor and Recipient for Two Subsequent Temporoparietal Flaps

Abstract

Summary: After a camel bite, a man lost much of his mid-face tissues, including right eye, nose, cheeks, upper lip, and palate. A free latissimus dorsi flap was used to simultaneously fill and cover the huge gap and to rebuild the new mouth roof. A few weeks later, it could also offer local hinged flaps working as raw beds to receive a converse scalping flap, and extended temporoparietal flaps were used for reconstruction of the nose and hairy upper lip, respectively. After 6 years, the face maintained height and width, and showed a marked sagittal shrinkage, obviously due to the absence of the vomero-maxillo-palatine skeletal axis. Despite this particular long-term inadequacy and flap insensitivity and inactivity, the new arrangement helped the patient to more easily socially integrate and to better eat, drink, and speak. This article highlights the consistency of free flaps to give and receive local and regional flaps.

The Importance of Reconstructing the Orbital Floor and Vomer-Palatal Sagittal Axes

“…A midface reconstruction with long-term collapse due to missed skeletal restoration was detailed. 1 The soft tissue restoration using a free musculocutaneous flap and two scalping flaps did not successfully maintain volume over time. Retrusion of the central area was attributed to the damaged vomer.…”