Materials and Methods: A retrospective study between 1988 to 2001 identified 69 patients with an average age of 55, sex ratio of 45M to 24F and T4 malignancies which required extended craniofacial resections. Tumor types of 49% SCC, 23% sarcoma, 10% adenocarcinoma, 6% BCC originated from face, sinus, ear and parotid areas. Forty-two percent (29/69) of patients underwent 2.4 previous surgeries prior to our resection. Tumor recurrence after resection and radiation occurred in 23% of the patients. All were reconstructed with free rectus myocutaneous flaps. Seventy-five percent of patients required skull base reconstruction and 52% received post operative adjuvant irradiation.

Results: Mean follow-up time was 31.4 months, and a median of 13 months. Early complications included 7 hematomas, 5 flap dehiscence, 4 arterial thromboses, 2 complete flap loss, 1 partial loss, 2 CSF leak requiring a lumbar drain insertion during the early post operative period, and 2 wound infections. Late complications included two ventral hernias and a palatal fistula in a patient with preoperative radiation. Flap loss rate was 3% (2/69). Overall complication rate was 26/69 (40%). No surgical mortality occurred.

Conclusion: Complex craniofacial resection of advanced tumor can be safely reconstructed with the free rectus myocutaneous flap.