Free tissue reconstruction of massive facial trauma - review of the literature and considerations to implement aesthetic and functional outcome

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.