Background: Facial reconstruction is often a difficult but rewarding challenge for the plastic and reconstructive surgeon. Lesions and defects resulting from congenital disease, trauma, and malignancy can leave patients with marked asymmetry and extensive soft tissue deficits. Familiar reconstructive techniques used for facial defects include local, regional, and distal flaps as well as skin grafting and tissue expansion. These well described treatment methods are not, however, without associated risks and complications. Axial pedicle flaps such as forehead flaps often require multiple procedures before an acceptable aesthetic outcome is achieved. Such operations include flap development, takedown and inset, followed by any number of minor revisions for defatting and final adjustment. Often, a patient's age or comorbid medical conditions preclude opting for a treatment plan requiring multiple or serial procedures. Also, patients that have undergone previous surgeries or radiation treatment can become limited in what further tissue rearrangement options may be available due to compromised vascular supply to particular skin or soft tissue regions. IntegraŽ is a bilaminate dermal regeneration template that has been proven to be effective as an adjuvant to skin grafting in the reconstruction of a variety of wound types. We have used it effectively in wound beds that are not amenable to skin grafting alone, i.e. over exposed tendon, bone, or joint space. These properties allow for cosmetically and functionally acceptable results when IntegraŽ is used for facial defect reconstruction..

Hypothesis: We propose that many facial defects can be effectively treated using IntegraŽ with or without skin grafting as an alternative to traditional local and regional flaps or skin grafting alone. The results of this method of treatment can yield comparable aesthetic and functional outcomes while often reducing the total amount of surgery that is required to obtain a final result.

Methods: A retrospective chart review was performed and preoperative and postoperative photographs were analyzed on patients treated with IntegraŽ with and without skin grafting for facial defect reconstruction. Charts were reviewed from January 2005 to August 2007 and the results of the reconstructions were evaluated for IntegraŽ take rate, skin graft take rate, infection, and revision procedures needed.

Results: We treated 43 patients during the study period with IntegraŽ for facial reconstruction. IntegraŽ take rate was 95%. Skin graft rate take was 92%. Infection rate was 2%. The percentage of patients requiring revision procedures was 30%.

Conclusions: Traditional reconstructive options are often not amenable to certain patient subsets with facial defects. Using IntegraŽ with subsequent skin grafting is a new option that still affords acceptable aesthetic and functional results. The use of IntegraŽ should be considered as another component of the reconstructive ladder in cases of challenging facial reconstruction.