Multiple reconstructive failed surgery - successfully managed with local flap

This video series contains gross images, graphic descriptions of gore surgical procedure. Viewer’s discretion strongly advised. Cannot be substituted for a professional medical/surgical advice

This is a case of a 32-year old male, a victim of road traffic accident. The entire right mid-face skeleton was lost exposing the underlying structures including nasal and mouth being exposed. He was unsuccessfully and repeatedly operated at several centers using distant flaps and micro-vascular surgeries. He had graft taken from abdomen, various regions of arm, legs, back and shoulders. All the grafts resulted in total failure. With each attempted surgery, more areas became involved leading a huge scarring and defect.

The immediate goal was to provide a structural cover and to close the defect with skin. As the entire vascularity of the area was compromised and no significant donor site available, a local forehead rotational flap harvest was chosen. After adequate preparation a medial forehead flap was raised and rotated to cover the defect of the right midface. Layer-wise suture was performed. The entire right midfacial defect was successfully closed