Microvascular replantation of extensive craniofacial amputations: case series

Abstract

Facial replantation is the preferred treatment for traumatic injuries because native tissue best preserves the unique contours and textures of the face. Successful outcomes depend heavily on the condition of the amputated tissue and the identification of viable vessels for anastomosis. This case series reviews the technical challenges and surgical techniques involved in two complex cases of multi-subunit facial replantation. In the first case, a near-total facial amputation involving the maxilla was salvaged through retrograde perfusion of the facial vein using a temporary arteriovenous inflow shunt to provide early perfusion. The second case involved a total scalp, bilateral ear, and eyelid avulsion that was replanted using bilateral superficial temporal artery and vein anastomoses. Both cases resulted in successful salvage with only partial necrosis, demonstrating that diminutive or unconventional vascular connections can still lead to viable outcomes. These cases reflect four decades of microsurgical advancement and demonstrate that innovative anastomotic strategies can overcome significant vascular limitations in extensive facial trauma.

Keywords

Facial replantation / craniofacial amputation / microvascular anastomosis / arteriovenous anastomosis / free flap

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