The UFFF was also preferred for its thinness and pliability (38%), reliable circulation due to perforators (18%), and the possibility of direct closure (49%) (Table 3). A.J. is a 67-year-old male who initially presented to the Otolaryngology-Head and Neck Surgery service at our institution with a left maxillary mass, biopsy positive for leiomyosarcoma. He was taken to the operating room with the Otolaryngology

service later that month where a left total maxillectomy and left orbital floor and orbital rim reconstruction were performed. this website A temporary obturator was placed and the orbital floor and rim were reconstructed with a titanium plate. Post-operatively, the patient received adjuvant chemotherapy and radiation. Approximately 6 months after surgery, the patient presented to Otolaryngology clinic with left facial cellulitis, ectropion, epiphora, and exposed

globe keratopathy. Silastic sheeting was seen to be protruding from the patient’s skin near the left medial canthus leaving a facial defect through which exposed hardware was visualized (Fig. 2). The patient was then seen by the Plastic Surgery service in consultation for reconstruction of the left maxillary defect. Consideration was Carfilzomib price given to free flap reconstruction using an anterolateral thigh versus vertical rectus abdominis myocutaneous flap versus RFFF. On exam, the patient was right-handed with positive modified Allen’s test findings suggesting the blood supply to the patient’s hands was radial artery-dominant (insufficient

collateral flow was noted through the ulnar artery with poor perfusion of the hand after release of the ulnar artery and observation for 15–20 seconds). The patient had a history of left wrist surgery resulting in a radial-based scar which precluded flap harvest from the left SPTLC1 side. The patient’s case was discussed in a joint conference with Otolaryngology, Oculoplastics, and Plastic Surgery. Given the patient’s responsibilities in caring for family members at home, it was felt that an UFFF would be the least likely flap to have complications and donor site morbidity and most likely to be closed primarily, thus allowing the patient to recover quickly and return to caring for his family. In addition, it was felt that the less hirsute UFFF would be preferable to a RFFF. The patient was taken to the operating room with the Otolaryngology and Plastic Surgery services; the exposed hardware was removed revealing a large, open cavity from the previous left total maxillectomy (Fig. 3). The remaining defect was reconstructed with a right UFFF (dimensions 3.5 × 10 cm, pedicle length 7 cm); perforating vessels of the ulnar artery were identified during UFFF harvest (Fig. 4).