ORIGINAL ARTICLE: PDF OnlyCustomized Composite Reconstruction of Extensive Midfacial DefectsKeller, Kevin M.D.; Vásconez, Henry C. M.D.; Keller, K; Váeconez, HC. Author Information Customized composite reconstruction of extensive midfacial defects. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, KY. Annals of Plastic Surgery: March 1998 - Volume 40 - Issue 3 - p 291-296 Buy Abstract We describe the treatment of 2 patients with extensive midfacial defects by using a customized composite flap. Autogenous bone was transferred from the iliac crest, revascularized by the rectus muscle, and then transferred as a complete unit by microvascular technique to provide a vascularized bone graft to this area of difficult reconstruction. The bone was shaped and customized to fit the osseous defect. Although the rectus muscle was relatively bulky at the time of harvest, its hearty blood supply permitted trimming and contouring to fit the gap. This technique was based on the principles proposed previously by other authors regarding the vascularization of a free bone graft and its transfer as a composite flap. This technique requires more research and refinement, however this clinical demonstration shows the feasibility of revascularizing a composite flap and the extent to which this technique can be performed. © Williams & Wilkins 1998. All Rights Reserved.