Microvascular Osteocutaneous Free-Flap Reconstruction of Complex Maxillary Defects: A Two-Year Single-Center Experience

Abstract

Maxillary defects resulting from oncologic resection, severe trauma, or invasive infections such as mucormycosis present significant reconstructive challenges due to the need to restore midfacial support, oral competence, speech, mastication, and facial aesthetics. Microvascular osteocutaneous free flaps have expanded reconstructive options by providing vascularized bone and soft tissue for simultaneous restoration of structural support and intraoral lining. This report describes our reconstructive experience in three patients who underwent microvascular reconstruction of complex maxillary defects at our institution over a two-year period. Etiologies included invasive mucormycosis in one patient and oncologic resection in two patients. Defects were classified according to the revised Brown classification, with one type IIIb defect involving the maxilla and orbital floor and two type V defects involving the maxilla and adjacent midfacial structures. Reconstruction was performed using free fibula osteocutaneous flaps in two patients and a radial forearm osteocutaneous flap in one patient, selected according to defect characteristics and tissue requirements. Bony segments were contoured to recreate the maxillary framework, while skin paddles were used for intraoral lining and oral-nasal separation. All flaps survived completely, with satisfactory healing, restoration of midfacial contour and support, preservation of oral competence and speech, and acceptable facial symmetry. Minor secondary contouring procedures were required in selected patients. No flap failures, major complications, or significant donor-site morbidity were observed. This case series demonstrates the application of osteocutaneous free flaps in the reconstruction of complex maxillary defects and highlights important technical considerations and the use of an algorithmic approach in flap selection based on the revised Brown classification.