Abstract
This article is to review the role of microsurgery in facial trauma reconstruction. Microsurgery was developed since 1960s and had been applied on facial trauma from 1970s to treat amputated scalp, nose, ear and lip. Microsurgical replantation of scalp and small parts of face restores function and achieves aesthetic results, but small size of vessels and venous drainage problems are most technical challenging. In this article, we reviewed many talented authors’ work to solve those problems in facial tissue replantation. If defects are huge, we need microsurgical free flaps for reconstruction. The current workhorse is anterolateral thigh flap and we reviewed the versatility and new concepts of the flap. Development of perforator flaps was another milestone of flap reconstruction because of better cosmetic result and lower donor site morbidity. We reviewed the concepts, history and application of perforator flaps. Finally, facial replantation developed in recent 5 years to treat extremely large facial defects which cannot be reconstructed with microsurgical flaps and traditional flaps alone. The task is complex and needs a large team to support the whole procedure. We also reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction.
Highlights
Trauma, tumor, cancer ablation and burn all result in facial tissue loss and deformity
We reviewed the facial allotransplantation, which is the ultimate application of microsurgery in facial trauma reconstruction
We review the replantation of facial organs, free flap reconstruction, especially anterolateral thigh flap, and concepts of perforator flaps
Summary
Despite the advanced development of free ALT flaps and perforator flaps, there are still situations that can’t be solved by flaps alone. Free tissue transfer and numerous autologous flaps can obliterate dead space but cannot match the delicate details of a completely amputated nose and a functional upper lip. Face transplantation has been shown far to be a viable option in some patients suffering severe facial deficits which are not amenable to current reconstructive techniques [134]. The fourth case ( the first case in United States) included maxilla and palate for near-total facial transplantation [142]. The Cleveland clinic used the parameters of Functional status, Aesthetic deficit, Comorbidities, Exposed tissue, Surgi-. Cal history to develop a FACES score to objectively stratify face transplant candidates for their facial deficit during multiple steps throughout the screening process [134]. The risks of mandatory lifelong immunosuppression should be deliberated by each institution’s multidisciplinary face transplant team [134]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
