The use of folded multi-island vertical rectus abdominis myocutaneous free flap (MI-VRAM) in reconstruction of complex midfacial defects

Introduction Complex midfacial defects after extensive cancer resection involve multiple aesthetic and functional subunits of the face. The golden standard of midfacial reconstruction includes oronasal separation, orbital obliteration, restoration of facial contours and restitution of missing epithelial surfaces. Herein, the rationale and outcomes for reconstruction of complex midfacial defects using a folded MI-VRAM flap are analyzed in this study.

Materials & Methods A retrospective review of prospectively collected database was conducted on all VRAM free flaps used in head and neck reconstruction in a single referral tertiary center from 2013 to 2020. A total of 39 cases were identified, of which 21 patients underwent immediate VRAM flap reconstruction for complex midfacial defects. Variables including age, sex, pathologic subtypes, tumor staging, type of resection, defect classification, adjuvant therapy, complications, follow-up time and reconstructive details were collected.

Results Single skin-island VRAM was used in 10 (47.6%) patients. 11 (52.4%) patients required the use of folded MI-VRAM flap. In 5 (23.8%) patients a double skin-island flap (DSI-VRAM) was used and 6 (28.6%) patients received a triple skin-island flap (TSI-VRAM). The average size of harvested skin paddle was 15×7.2 cm. The rate of surgically induced complications was 28.6%, including CSF leakage, fistula formation, postoperative hematoma, and prolonged wound healing. There were no cases of total flap loss and no major donor site complications recorded.

Conclusions Folded MI-VRAM flap is a reliable method for reconstruction of complex midfacial defects. It provides multiple independent skin islands with excellent plasticity and abundant volume of tissue for restoration of facial contours.

Publication History

Article published online:
24 May 2022