The sandwich epicranial flaps.

Sandwich epicranial flaps are prefabricated composite flaps that have multiple uses in reconstructing the middle and the lower facial region. Sandwich epicranial flaps always comprise the galea and a full-thickness skin graft; they may, in addition, include the temporal muscle and a fragment of parietal bone. According to their composition, four types of sandwich epicranial flaps are described. Experience with a use of 36 sandwich epicranial flaps (13 with vascularized bone) is reported. A few examples demonstrate the use of sandwich epicranial flaps in dramatic facial mutilation following noma in children. The sandwich epicranial flap can be performed at any age, does not require microsurgical anastomoses, and has a low complication rate. It is particularly useful for major reconstructive procedures in children.