Original ArticlesMicrovascular Tissue Transfers for Midfacial and Anterior Cranial Base ReconstructionAksu, Ali Emre MD; Uzun, Hakan MD; Bitik, Ozan MD; Tunçbilek, Gökhan MD; Şafak, Tunç MDAuthor Information Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey. Address correspondence and reprint requests to Ali Emre Aksu, MD, Associate Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey; E-mail: email@example.com Received 23 May, 2016 Accepted 2 November, 2016 The authors report no conflicts of interest. Journal of Craniofacial Surgery: May 2017 - Volume 28 - Issue 3 - p 659-663 doi: 10.1097/SCS.0000000000003448 Buy Metrics Abstract Reconstruction of a midfacial defect can represent a difficult challenge for the plastic surgeon. Although many midfacial deformities have traumatic or congenital origins, the vast majority of head and neck defects occur after resection of malignant head and neck neoplasms. Autogenous reconstruction is now routinely performed for larger, complex defects resulting from surgical resection or trauma. In this study, the authors present 27 patients with midfacial defects reconstructed with free flaps. Twenty-two of the defects were created by surgical ablation of cancer (maxillectomy) and the others were traumatic. The maxillectomy defects were classified into 4 according to the classification proposed by Cordeiro. Eighteen of the patients were male and 9 were female. Twenty-nine free flaps were performed. Six different types of flaps including radial forearm flap, vertical rectus abdominis (VRAM) flap, anterolateral thigh (ALT) flap, tensor fasciae latae (TFL) flap, fibula osteocutaneous flap, and iliac osteocutaneous flap were accomplished. Types I and II defects were reconstructed with radial forearm flap. Type III defects were reconstructed with VRAM and ALT. Type IV defects were reconstructed with VRAM and TFL. Two patients underwent a second flap reconstruction due to recurrent disease (9.1%). Average patient age was 53.1 years. Free-flap survival was 100%. Free tissue transfer is the method of choice in midfacial reconstruction. Following a reconstructive algorithm is useful in the decision-making process for patient evaluation and treatment. Every reconstructive microsurgeon might have different experiences with different flaps. Therefore, the algorithm for flap choices is not universal among surgeons. © 2017 by Mutaz B. Habal, MD.