Microsurgery in Maxillofacial Surgery

Microsurgery in maxillofacial surgery — reconstruction of facial, jaw and neck defects by transplanting the patient's own tissues with microsurgical vessel anastomosis. At Iskusstvo Clinic — the school of Professor Nerobeev, pioneer of reconstructive microsurgical facial surgery in Russia.

Duration4–12 hours

Rehabilitation7–14 days

Free Flap Transplantation Using Microsurgical Technique

Harvesting skin-muscle flap with vessels, microsurgical artery-vein anastomosis under microscope for facial reconstruction after cancer and trauma.

Revascularized Bone Grafting

Revascularized bone grafting reconstructs maxillofacial defects using free bone transplants with microsurgical vascular anastomosis. ъ

Available sections:

Indications for Microsurgical Reconstruction

Extensive soft tissue defects of the face and neck following tumor removal
Defects of the mandible or maxilla following resections for neoplasms
Deep post-traumatic defects with loss of multiple tissue layers
Facial tissue reconstruction after radiation therapy when local tissues are non-viable
Consequences of osteomyelitis or necrotizing infections with extensive tissue destruction
Neurofibromatosis with severe facial deformities
Cases where previous reconstruction methods have failed

Two Primary Methods

Free Flap Transfer with Microsurgical Technique

Transfer of the patient's own tissue (skin, muscle, or a combination) from a donor site to the defect area. After transfer, the supplying vessels are sutured under the microscope. Used to reconstruct soft tissues of the face, oral cavity, and neck. The flap type — radial forearm, anterolateral thigh, thoracodorsal — is chosen based on the specific reconstruction goals.

Revascularized Bone Grafting

Transplantation of a living bone graft with its own blood supply. Unlike conventional bone grafting, revascularized bone receives its own blood flow at the recipient site — ensuring reliable engraftment for large defects and in irradiated tissues. The fibular osteocutaneous flap is most commonly used, enabling subsequent dental implant placement.

How the Surgery is Performed

Each microsurgical procedure is preceded by detailed planning: CT scanning, vascular anatomy assessment, and 3D modeling when necessary. All procedures are performed under general anesthesia; typically two teams work simultaneously — one preparing the defect site, the other harvesting the flap. After tissue transfer, microvascular anastomosis is performed under the operating microscope. Duration ranges from 4 to 12 hours depending on the scope; exact timelines are determined individually.

Risks and Complications

The most significant specific risk is thrombosis of the vascular anastomosis with compromised flap perfusion. If detected promptly (within the first hours), repeat surgery to restore blood flow is possible. General risks include anesthetic complications, infectious complications, and healing disturbances. All risks are discussed with the surgeon during an in-person consultation.

Contraindications

Absolute and relative contraindications are established during preoperative assessment. General limitations include severe systemic diseases in decompensated stage, uncorrectable coagulation disorders, and severe atherosclerosis. The final decision is made by the surgeon after complete evaluation.

Why Iskusstvo Clinic

Nerobeev's School — a living microsurgery tradition. Professor A.I. Nerobeev was a pioneer of facial microsurgery in Russia; the clinic's surgeons are his direct students who practiced at the Clinic of Reconstructive Surgery of the Face and Neck at TsNIIS i ChLKh.

Infrastructure for complex operations. 5 operating rooms, 12 inpatient rooms, equipment at the level of leading federal centers — everything needed for 6–12 hour procedures with full anesthetic support.

Comprehensive approach. Oncosurgery with simultaneous reconstruction, subsequent dental implantation, follow-up — all in one clinic, without patient transfer.

Frequently Asked Questions

How does a free flap differ from local tissue plasty?
In local plasty, tissues are moved from adjacent areas while maintaining connection to the body. A free flap is completely detached from the donor site and transferred with vessel transection; circulation is restored microsurgically. This allows tissue to be moved from any suitable donor zone to close defects of any location and volume.

Is surgery possible after radiation therapy?
In most cases — yes. Revascularized flaps have an advantage over local plasty in irradiated tissues: they bring their own blood supply, independent of surrounding tissue condition.

Is special preparation required before surgery?
Yes. In addition to standard examination, Doppler ultrasound of donor zone vessels, CT angiography, and specialist consultations may be required. Preparation is planned individually by the surgeon.

How long does the patient stay in hospital?
Typically 7 to 14 days depending on scope and recovery rate.

Does the flap always survive?
Modern microsurgery achieves a high rate of successful engraftment, but there are no guarantees. Complication rates depend significantly on the surgical team's experience. With early diagnosis of thrombosis (first hours), repeat surgery is possible.

BEFORE & AFTER

The best proof of mastery is the happy faces of our patients. Real examples of transformation without photoshop or retouching.