Aesthetic and functional outcomes after microsurgical reconstruction of the maxillofacial region are of utmost importance. The purpose of this chapter is to outline a list of critical concepts for this type of reconstruction developed over the past decade at our high-volume trauma center: (1) aesthetic unit appearance, (2) defect boundaries, (3) tissue requirements, (4) provision of vascularized skeletal buttress framework, (5) ample soft tissue volume, (6) early reconstruction, and (7) local revisional cutaneous replacement through multistage planning. The free flaps most commonly used for maxillofacial reconstruction at our institution are discussed, outlining their history, anatomy, surgical techniques for harvest, and advantages/disadvantages. The flaps described include the ulnar forearm flap, anterolateral thigh flap, groin flap, deep circumflex iliac artery flap, and fibula flap.
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