Deformities resulting from a totally burned face presents as a profound challenge to the reconstructive plastic surgeon. Traditionally, skin grafting has been used for resurfacing but with limited success, especially when the burn was so severe that it destroyed the deeper facial structures. Angrigiani et al reported a novel method for total face reconstruction using the bilateral extended scapular free flaps. Although this method obtained better aesthetic and functional results compared to skin grafting, donor site morbidity was relatively high with a large scar that extended across the entire back area. In addition, the nose needed to be reconstructed separately using the forehead flap or the free radial forearm flap. We present a case in which we successfully reconstructed a totally burned face with a single free expanded flap. A 56-year-old man received severe burns with gasoline to the face, the anterior neck, the anterior chest, and the bilateral upper extremities. There was also a complication of severe inhalation injury resulting in complete laryngeal obstruction necessitating tracheotomy. The nose and the bilateral ears were burnt and lost. Sequential debridment and skin grafting were required for the closure of the burn wound. This resulted in a face sans a nose, the ears the lips and normal skin with a completely contracted appearance. Prior to facial reconstruction, a tissue expander (1500 ml) was inserted in the left back. Surgical delays were performed to prevent a central necrosis caused by the incisions for opening the eyes and mouth. Six months after the insertion of the tissue expander, the left back skin was transferred to the face as one large flap sized 28 x 27 cm with three different vascular pedicles (i.e. the left circumflex scapular artery and vein, the lateral cutaneous branch of the 7th intercostal artery and vein, and the dorsal branch of the 8th posterior intercostal artery and vein). These vascular pedicles were anastomosed to the left superficial temporal artery and vein, the left facial artery and vein, and the right superficial temporal artery and vein, respectively. The flap survived totally with abundant tissue remaining at the central area for nasal reconstruction. This allowed for the excellent shape of the nose to be restored, with the additional 5 procedures including a costal cartridge graft.. Facial reconstruction with the single expanded flap did not require a separate procedure for nasal reconstruction, and donor site morbidity was minimal. To our knowledge, this is the first successful reconstruction of the entire face including the nose with one single expanded flap.
View Synopsis (.doc format, 499.0 kb)