Aim: Complex central facial defects are often difficult to manage due to the extent of the injury and the multi-planar nature of the deficit. The aim of this presentation is to show that such complex defects can be managed effectively with prelaminated free flaps such as the radial forearm and the fibula.

Materials and Methods: During the period Sept 1999 – June 2001, four patients with severe and complex facial defects were treated in our unit. The causes of injury were gunshot, in two cases, electrocution and burns. The facial structures damaged included the mandible, nose, upper and lower lip, floor of the mouth, hard palate, forehead and cheeks.

Reconstruction was achieved with the use of prelaminated free flaps, mainly radial forearm and fibula. The tissues used for the prelamination were skin graft and conchal cartilage (where appropriate).

The techniques used in each case will be illustrated. Experiences derived from prelaminating the fibula flap will be discussed.

Results and Discussion: All flaps survived and the patients achieved a satisfactory aesthetic result, taking into consideration the extent of their injuries. Reconstruction of structures like the nose and upper and lower lips require bilaminar flaps. (Lining and cover). Prelaminating flaps such as the radial forearm and the fibula (skin paddle) enables one to create “thin” bilaminar flaps, ideal for such reconstructions. The need for a further flap (free or local) is thus eliminated.