Reconstruction of through-and-through facial defects with combined anterior tibial flap and dorsalis pedis flap.

Through-and-through facial defects can be the result of malignancy, malformations, or trauma and pose a challenge for reconstructive surgeons. An ideal reconstruction of such defects should restore both lining and external skin defects at the same time. In this report, we describe the use of combined anterior tibial flap and dorsalis pedis flap to reconstruct complex facial defects. Six patients who presented with through-and-through facial defects were included. The cause of defects were trauma, radiotherapy, or flap necrosis, and defect locations were the buccal (3 patients), oral region (2 patients), and frontal (1 patient). The outer defects were between 5 × 6 cm and 13 × 9 cm, whereas the inner defects were between 3 × 3 cm and 5 × 6 cm. The anterior tibial flaps that were used to cover the outer defects ranged from 5 × 8 cm to 10 × 15 cm, and the dorsalis pedis flaps that were used to reconstruct the lining ranged from 3 × 4 cm to 6 × 8 cm. Donor sites were covered with skin grafts. No flap failure was evident, and a good aesthetic outcome was obtained in all cases. In 1 patient, the skin graft on the dorsal pedis presented partial necrosis and ultimately healed by dressing change. Compared with other techniques, the combined anterior tibial flap and dorsalis pedis flap possesses the potential benefits of being thin and pliable and having reliable vascularity. It brings a new alternative method for complex facial defect reconstruction.