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 FIG. 7-18. Lateral view. Revisions and liposuction courtesy of Larry T. Foster, M.D.
CASE 3
A 15-year-old boy with Hanhart's syndrome had had 20 previous reconstructive procedures. (Courtesy of Dr. Bernard Alpert.)
 FIG. 7-19. The syndrome consists of congenital absence of the mandible and multiple anomalies of the palate, pharynx, and lower face.
 FIG. 7-20. Close-up view.
 FIG. 7-21. Lateral view shows the mandibular agenesis and prominent neck contracture.
 FIG. 7-22. The BIEF is marked on the lower abdomen, including the location of the superficial epigastric vessels.
 FIG. 7-23. Bilateral pedicles are dissected out and tagged with vascular loops.
 FIG. 7-24. Once the donor pedicles have been isolated, the flap is elevated from superior to inferior.
 FIG. 7-25. The recipient site scar has been released. A mesh spacer has been placed between the mandibular remnants in anticipation of bony reconstruction.
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 FIG. 7-26. First-stage reconstruction is completed, with the neck scar excised. An excess of soft tissue is now available for later refinement.
 FIG. 7-27. Second-stage reconstruction is seen, with placement of bilateral lower cheek expanders. Rib grafts have been placed for bony reconstruction of the mandible.
 FIG. 7-28. Third-stage reconstruction. Tissue expanders have been removed and flaps advanced.
CASE 4
A woman had a breast defect after modified radical mastectomy.
 FIG. 7-29. Appearance before BIEF procedure.
 FIG. 7-30. Anatomic outline of flap.
 FIG. 7-31. The BIEF has been incised.
 FIG. 7-32. The entire flap has been modified, preserving the two SIE pedicles plus the deep inferior epigastric pedicle (DIE) on the left side.
 FIG. 7-33. The flap is inset after scar resection.
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