The main reconstructive operations, mainly flaps and grafts and their subsequent likely postoperative progress are outlined below. The discussion is focussed on the donor sites as these are not emphasised elsewhere. Issues related to progress at recipient sites are discussed in the relevant pages, mainly pages about the treatment of oral, facial skin and salivary gland malignancies, cleft lip and palate, craniofacial anomalies, jaw disproportion, hard & soft tissue necrosis.


Split skin grafts

Full thickness skin grafts

The great advantage of full thickness skin grafts is that the donor-site wound is closed by wide undermining and suturing.

Buccal mucosa grafts

Palatal mucosal grafts

These are like split skin grafts (see above) and leave a raw area which heals with a dressing.

Fascial grafts

Harvested subcutaneously, these graft wounds are only evident because of the skin incision used to gain access to them.

Free bone grafts


The pelvis is by far the commonest site for maxillofacial bone graft harvesting as it can offer small amounts of cancellous bone to large bi-cortical segments. The postoperative progress is therefore widely variable.


This site is used mainly for alveolar bone grafts in cleft patients as it produces adequate amounts of cancellous bone but no cortical bone.


Only really used now for condylar replacement in children.

Cartilage grafts

The postoperative path is dependent on the donor site. Rib cartilage is similar to rib bone, although less painful. For ear and nose donor sites only the skin suture line is noticed.

Nerve grafts

All nerve grafts leave a deficit from where they were taken. This is very much a balancing act. Will the hoped-for benefit (usually an important motor nerve function or a very important sensory nerve) be worth the definite loss of function (usually sensory in a less important area) be worth it? Wherever the nerve graft is taken from, the area will be numb to a greater or lesser extent permanently, although some minor improvements are described probably because of contributions by surrounding intact nerves


Local flaps

A nasolabial flap – taken from the looser facial skin to the side of the nose.

A tongue flap - whether based on the front, back or side of the tongue, this flap is frustrating because it requires part of the tongue tissue to be stitched to another part of the mouth for three weeks.

A buccal fat pad flap - a useful extension of a simple buccal mucosal advancement flap.

There are numerous different local skin flaps – such as rhomboid, bilobed, subcutaneous advancement flaps. There are lots of local skin flaps used in facial skin surgery, especially facial skin cancer surgery but they all follow similar pathways.

The submental flap – varies in popularity; a large area of skin from underneath the jaw line is taken.

Regional flaps

A forehead flap – quite an old flap with limited applications, but can provide an exceptional reconstruction for extensive nasal skin defects.

A deltopectoral flap - another old-school flap which can be very useful on specific occasions.

The pectoralis major flap - the workhorse flap for the 1980s, and finding a role in special cases even now.

A latissimus dorsi flap - of more use in breast reconstruction than head and neck reconstruction as a pedicled flap, but used in specific instances. In head and neck reconstruction more often used as a free flap (see below). A bulky connection is present when used as a pedicled flap, when it is tunnelled underneath the skin of the armpit and this gradually atrophies in the same way as the pectoralis major flap (see above).

Free flaps

The radial forearm flap – for 40 years the gold standard intra-oral reconstruction for thin, flexible stretchy areas. The donor site on the forearm has been progressively improved over the last 40 years, although suture lines will stay remain visible.

The fibula flap - the most commonly used single, combined bone and soft tissue facial reconstructive flap. The fibula is a fantastically useful free flap with relatively acceptable donor site morbidity.

The deep circumflex iliac artery flap - major bone flap with unfortunate postoperative issues in its original design, but much less problematic using newer computer guided techniques and a medial (from the front) approach. Rarely used with skin as the skin paddle is not very reliable

The anterolateral thigh flap - valuable intermediate size, soft tissue flap. The donor site is virtually always closed primarily and is in a less visible area.

The rectus abdominus flap - the bulkiest soft tissue flap, useful in very cachexic patients or when massive bulk is required. In its basic form there is a substantial donor site series of issues to address, but a combination of operative technique modifications can reduce these.

The latissimus dorsi flap - almost as bulky as the rectus abdominus flap (see above) but with less fat. Patient positioning during surgery is probably the reason why it is not quite as popular as it should be.

The scapula flap - a divisive flap, full of potential in some people’s eyes, more trouble than it is worth in others’.

Note that the perforator flaps taken from the sites discussed above have similar but usually very much reduced postoperative sequalae, being designed to minimise the amount of tissue harvested in order to reduce the donor site morbidity.

There are many other flaps. However, the most frequently used in maxillofacial reconstruction are listed above. Some units specialise in flaps not used commonly elsewhere (for example, the ulnar flap (another forearm flap)). It is worthwhile asking those who have greater experience (your treating clinician) about what to expect after your operation.