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Pang et al. Plast Aesthet Res 2021;8:49 Plastic and
DOI: 10.20517/2347-9264.2021.42
Aesthetic Research

Review Open Access

Free tissue reconstruction of massive facial trauma -
review of the literature and considerations to

implement aesthetic and functional outcome

John Pang, Harrison Cash, Neal Futran
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 98195, USA.
Correspondence to: Dr. Neal Futran, Department of Otolaryngology-Head and Neck Surgery, University of Washington, 1959 NE
Pacific St, Seattle, WA 98195, USA. E-mail: nfutran@uw.edu

How to cite this article: Pang J, Cash H, Futran N. Free tissue reconstruction of massive facial trauma - review of the literature
and considerations to implement aesthetic and functional outcome. Plast Aesthet Res 2021;8:49.
https://dx.doi.org/10.20517/2347-9264.2021.42

Received: 3 May 2021 First Decision: 8 Jul 2021 Revised: 9 Jul 2021 Accepted: 28 Jul 2021 First online: 10 Aug 2021

Academic Editors: Matthew Spector, Mark K. Wax Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
The surgical armamentarium for the treatment of massive facial trauma has undergone a dramatic shift from early
management strategies. Although tenants of acute trauma management continue to prioritize airway management
and cardiopulmonary support, improved functional outcomes are achievable with an emphasis on early definitive
free tissue transfer. The use of workhorse donor flaps, such as the radial forearm, fibula, and latissimus, have
become the standard of care. An emphasis is placed on the separation of cranial, sinonasal, and oral contents and
restoration of form and function. Here, we also discuss the management of telecanthus, nasal defects, and
microstomia - sequelae which represent unique challenges to the reconstructive surgeon. The ability to perform
virtual surgical planning and facial transplantation will likely shape future paradigms and represent the need to
perform ongoing research.

Keywords: Facial trauma, free flap, free tissue, reconstruction

INTRODUCTION
Massive facial trauma presents a historically complex problem for patients and those charged with
management and reconstruction in this setting. The patient must first be stabilized at initial presentation,

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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