Y-shaped venous anastomosis combined with free flap for the treatment of complex craniofacial trauma

Background: Complex craniofacial trauma is defined as those traumatic injuries that are not responding to initial treatment and may involve chronic infection, tissue exposure, and soft tissue contusions. Typical reconstruction using a Y-shaped microvascular venous anastomotic free flap is labor intensive. Although free flap grafts have been used in many applications, their use for combined microvascular anastomotic therapy remains an unexplored but attractive possibility.

Purpose: Correcting facial contour trauma is challenging because it requires careful planning of flap design, composition, and ancillary procedures METHODS: This study analyzed a retrospective cohort of 28 craniofacial trauma patients (18 males; 10 females) who underwent Y-shaped microvascular venous anastomosis free flap grafting for treatment of the defects between January 2020 and January 2022, and were followed up for more than 6 months after the procedure.

Results: The causes of defects were high-voltage electrical injuries (n=12), after excision of scalp malignant tumors (n=8), grade III burns (n=6), and trauma (n=2). By adjusting the height of the tissue and the different tissue components, the flaps were designed in three dimensions by contour mapping so that they had different thicknesses depending on the defect. Custom-sized flaps with a reliable envelope were taken while minimizing the loss of overlying skin. 6 flaps were based on two perforators, and another 19 were based on one perforator. Nine flaps were harvested in an inlay fashion. All flaps were fully viable and no donor lesions were present in any case. Contour and symmetry were improved in all patients, and all grafted patients were evaluated for pre- and postoperative aesthetic restoration.

Conclusions: Our findings suggest that the Y-shaped microvascular venous anastomosis free flap approach may be a reliable alternative for aesthetic reconstruction of facial contour trauma.