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Design of a Modified Monobloc Composite Facial Allograft Technique in Facial Reconstruction

Bastidas, Nicholas M.D.; Gerety, Patrick M.D.; Taylor, Jesse A. M.D.

Plastic and Reconstructive Surgery: March 2013 - Volume 131 - Issue 3 - p 537–543
doi: 10.1097/PRS.0b013e31827c6eba
Reconstructive: Head and Neck: Original Articles

Background: Composite facial allografts have become increasingly popular in the reconstruction of complex facial defects. Good to excellent aesthetic results can be achieved, particularly when a foundation of donor skeleton has been transferred. The authors propose using a conventional craniofacial technique (monobloc osteotomy) to transfer a thin monocortical foundation of bone, even in lieu of a skeletal defect, to improve the recipient periorbital and malar aesthetics.

Methods: The monobloc osteotomy approach was used to obtain a full facial allograft and modified ex vivo to a thin monocortical layer and transferred to an anatomical facial skeleton. The authors have named this the “masque” flap because of the resemblance of the outline of the foundation of bone to a costume worn in masquerade balls.

Results: The masque flap was performed on two fresh-frozen cadavers. The total time to harvest and thin the osteomyocutaneous flap was 155 minutes (30 minutes to modify it ex vivo). The average total surface area was 1060 cm2. Periorbital and malar ligaments were maintained, as was the integrity of the canthal tendons.

Conclusion: The modified monobloc composite facial allograft technique allows transfer of a full facial allograft and maintains malar projection and excellent shape of the palpebral aperture.

Philadelphia, Pa.

From the Hospital of the University of Pennsylvania.

Received for publication May 15, 2012; accepted September 27, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Nicholas Bastidas, M.D.; 10 Penn Tower, 3400 Spruce Street, Philadelphia, Pa. 19104,

©2013American Society of Plastic Surgeons