Experience with the rectus abdominis myocutaneous flap with vascularized hard tissue for immediate orbitofacial reconstruction.

For a considerable tissue defect of the orbitofacial region after skull base or head and neck tumor en bloc extirpation, we have developed the "flying buttress" technique using the vascularized hard tissue rather than the multi-stage operative method using bone graft or alloplastic materials. The procedure reconstructs the inferior orbital rim and the zygomatic prominence--flying buttresses bridging transversely in a missing face--with free flap coverage, simultaneously in the primary surgery so that the bony structure is maintained for years and ptosis of a large flap is minimized. We prefer to use the rectus abdominis myocutaneous flap for tissue restoration and two types of vascularized hard tissue: the costal cartilages combined with the flap and the temporalis muscle-pedicled calvarial bone. Representative cases are illustrated and the technique is detailed.