Functional and Aesthetic Outcomes of Chimeric vs. Single Free Flaps in Midface Reconstruction Following Tumor Resection: A Retrospective Analysis.

Abstract

<b>Background/Objectives:</b> Locally advanced midface malignant tumors require extensive resection, resulting in complex defects involving bone and multiple soft tissue structures. Reconstructing these substantial defects presents a significant challenge to restore both function and aesthetics. This study aims to compare the functional and aesthetic outcomes of chimeric free flaps versus single free flaps in midface microvascular reconstructions. <b>Methods:</b> This retrospective analysis included fifty consecutive patients with Type III Cordeiro defects who underwent midface reconstruction with free tissue transfer between 2020 and 2024. The cohort included fourteen patients who received prefabricated chimeric flaps and thirty-six patients who received single free flaps. Outcomes were assessed six months postoperatively using a modified University of Washington Quality of Life Questionnaire (UW-QOL), analyzing domains including speech, chewing, sensation, appearance, pain, and social activity. Statistical analysis was performed using the Mann-Whitney U test. <b>Results:</b> In the chimeric flap group, no major flap necrosis or complications were observed. In unadjusted comparisons, the chimeric flap group showed higher transformed UW-QOL scores in several domains. Statistically significant between-group differences were observed for opening and speech (<i>p</i> = 0.004), change in appearance (<i>p</i> = 0.022), sensation (<i>p</i> = 0.011), and social activity (<i>p</i> = 0.006). Aesthetic outcomes, assessed via patient rating of appearance, were also significantly higher in unadjusted comparisons with the chimeric flap approach. Furthermore, in Type IIIa defects, titanium mesh successfully provided reliable orbital support. <b>Conclusions:</b> Chimeric free flaps represent a feasible reconstructive option in selected cases of complex maxillary and midface reconstruction. Their main advantages-providing the proper amount of specific, well-vascularized tissue and offering greater mobility of components- may be associated with more favorable functional, aesthetic, and social outcomes in unadjusted comparisons compared to reconstruction using single free flaps.