[Facial reconstruction with microsurgical tissue transfer].

Although regional flaps are the first choice for face reconstructions, large defects require tissue transfer from other parts of the body. Pedicled musculocutaneous flaps or free flaps are then the choice. Retrospective analysis of our cases of 42 pedicled and 58 free flaps between 1990 and 1999 showed a lower complication rate for free flaps. Moreover, free flaps offer the possibility of choosing from a variety of flap types, including thin fasciocutaneous perforator flaps, bulky musculocutaneous flaps and composite flaps with vascularized bone. Complex reconstructions of the face may require chimera and prefabricated flaps. Our choice then is the scapular region, where the subscapular vessels can carry independent tissue blocks of skin, bone and muscle. We demonstrate the reconstruction of the nose, palate and alveolar crest of the maxilla with such a prefabricated chimera flap.