Repair of composite zygomatico-maxillary defects with free bone grafts and free vascularized tissue transfer.

Introduction: Three-dimensional repair of the zygomatico-maxillary defect calls for an elaborate technique to achieve facial symmetry and correct globe position. We present a technique, which combines the use of a free vascularized soft tissue flap and free bone grafts for repair of composite zygomatico-maxillary defects. Patients: Three patients that underwent radical resection of the maxilla and the zygoma have undergone facial reconstruction using this technique. The mean follow up was 9 months. Methods: The key points of this technique are: (1) precise reconstruction of the zygomatico-maxillary complex including the orbit; (2) creation of a skeletal framework for canthopexy and suspension of the free flap; (3) repair of through-and-through soft tissue defects with a folded musculocutaneous free flap; and (4) simultaneous harvesting and reconstruction using two surgical teams to reduce the duration of surgery. Results: Reconstruction of the zygomatico-maxillary complex could be successfully accomplished in a single surgical procedure. Conclusion: This paper presents a method of repairing zygomatico-maxillary defects with free bone grafts and vascularized soft tissue. However, this concept has yet to be reviewed in the long term.