A Case of Complex Facial Reconstruction Illuminates Paul Tessier's Surgical State of Mind.

Successful head and neck reconstructions tackle both morphological and functional issues within treatment plans involving multiple coordinated steps. Nowadays, biomaterials, computer-assisted surgery, and free tissue transfers have greatly increased the potentialities of craniofacial surgeons. In the 1970s, when Paul Tessier, one of the founders of modern plastic surgery, was at the peak of his career, complex reconstructions had little technology to rely on. Here we report a case of facial reconstruction after gunshot trauma performed by Paul Tessier based on his "craniofacial autarchy" principle, that is using solely local flaps and grafts harvested in the head and neck area. This case involved 30 procedures on the mandible, maxilla, chin, lips, and nose. Based on data from the archives from the "Association Française des Chirurgiens de la Face" (Amiens, France) we provide details on Tessier's approach to surgical planning and on his global conception of treatment plans in reconstructive surgery.