FIG. 20-64. Frontal view.

FIG. 20-65. View through orbit into posterior nasopharynx.

FIG. 20-66. Intraoral view. Palatal defect.

FIG. 20-67. One team of surgeons exposed the recipient area through a Ferguson incision through the full thickness of the left side of the upper lip. The anterior facial vessels were exposed on the left side in the submental region.

FIG. 20-68. A second team developed a myocutaneous flap from the symphisis to the xiphoid, mobilizing the entire underlying left rectus muscle and an overlying ellipse of skin approximately 8 cm to 10 cm in width. Skin markings.

FIG. 20-69. Myocutaneous transplant next to recipient wound.

FIG. 20-70. The microvascular flap was then brought into position. The pedicle was brought out subcutaneously through a tunnel in the upper left neck.

FIG. 20-71. The skin flap was then cut into three separate islands by cutting down to the underlying muscle, preserving all perforators from the muscle. The first island was used to repair the floor of the palate, the second island for the medial wall of the nasal cavity, and the third island to fill the defect of the exenterated left orbit.

FIG. 20-72. Postoperative frontal view.

FIG. 20-73. Side view.

FIG. 20-74. Intraoral view showing closed palatal defect.

References

1. Boyd, J.B., Taylor, G.I, and Corlett, R.: The vascular territories of the superior epigastric and deep inferior epigastric systems. Plast. Reconstr. Surg. 73:1, 1984.

2. Pennington, D.C., Lai, M.F., and Pelly, A.D.: The rectus abdominis myocutaneous free flap. Br. J. Plast. Surg. 33:277, 1980.

3. Taylor, G.L, Corlett, R.J., and Boyd, J.B.: The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br. J. Plast. Surg. 37:330, 1984.

4. Shaw, W.W.: Microvascular free flap breast reconstruction. Clin. Surg. 2 2:333, 1984. 5. Bunkis, J., Walton, R.L., and Mathes, S.: The rectus abdominis free flap for lower extremity reconstruction. Ann. Plast. Surg. 22:373, 1983.

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