Vascularized Calvarial Bone Flaps and Midface Reconstruction

After studying this article, the participant should be able to: 1. Identify the fascial layers of the temporalis region. 2. Understand the three-dimensional nature of the orbit and upper maxillectomy defects. 3. Understand the surgical harvest of temporalis flaps and temporoparietal flaps with vascularized bone. 4. Appreciate preoperative risk factors and postoperative complications. Although vascularized calvarial bone grafts were originally explored for use in reconstruction of midface hypoplasia defects, they offer significant value in application to oncologic reconstruction of the midface. A review of eight cases of midface reconstruction using vascularized calvarial grafts was performed to illustrate the versatility and dependability of these flaps. Adequate bony and soft-tissue contours were achieved with no clinical evidence of bone graft resorption. No immediate postoperative complications including infection and hematoma or seroma formation were noted. One patient experienced a delayed sinusitis from a blocked duct. The use of vascularized calvarial grafts supported by temporoparietal fascia, combined deep temporal fascia, and temporalis muscle provides excellent soft-tissue coverage and adequate bone stock for reconstruction of complex defects. Maintaining vascularization of the bone graft not only resists infection but also opposes resorption associated with nonvascularized grafts, particularly those in compromised wounds.