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Most defects requiring coverage were classified as class II (\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      70, 71.4%; 18 (25.7%) bony vs. 52 (74.3%) soft tissue) or class IV (\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      16, 16.3%; 4 (25.0%) bony vs. 12 (75.0%) soft tissue) according to Brown and Shaw. The proportion of other horizontal defect classes was significantly lower (\n                      <jats:italic>n\u2009=\u2009<\/jats:italic>\n                      12, 12.2%; all soft tissue). Unilateral defects were present in 81 cases (82.7%; 15 (18.5%) bony vs. 66 (81.5%) soft tissue), while bilateral defects were observed in 17 cases (17.3%; 7 (42.2%) bony vs. 10 (57.8%) soft tissue). Postoperative complications were observed in 57 cases (58.2%), predominantly comprising minor issues such as bleeding or wound healing disorders. Major complications, including the need for transplant revisions, occurred in 9 cases (9.2%), with early transplant loss in three instances. No significant correlation was found between transplant loss and defect classification (\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.73) or transplant type (\n                      <jats:italic>p\u2009=\u2009<\/jats:italic>\n                      0.07). However, bony flaps demonstrated a higher tendency towards flap loss compared to soft tissue flaps (18.2% vs 4.0%). Dental rehabilitation using dental implants was performed in only 18.2% of all patients who received bony reconstruction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The complication rate associated with microvascular reconstructions was relatively high. Most complications were minor and could be managed therapeutically. Major complications, such as flap failure, remained relatively uncommon.<\/jats:p>\n                    <jats:p>Neither defect size nor transplant type used demonstrated a significant impact, though bony transplants showed a higher tendency towards flap loss.<\/jats:p>\n                    <jats:p>Despite the observed complication rate, free flaps continue to represent a reliable treatment option for patients with midfacial defects. In cases where bony reconstruction is not strictly necessary, dental rehabilitation using patient-specific preprosthetic implants may offer a viable alternative to bone grafts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10006-026-01566-0","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T02:12:33Z","timestamp":1778292753000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Microsurgical reconstruction in midface defects based on defect morphology and size \u2013 Reconstruction techniques, complications, and outcomes"],"prefix":"10.1007","volume":"30","author":[{"given":"Felix","family":"Neumann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Gomme","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Fenske","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Lampert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Wagendorf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedrich","family":"Mrosk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Hofmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Nahles","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Heiland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kilian","family":"Kreutzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna-Christina","family":"Sofroniou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Doll","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Koerdt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,9]]},"reference":[{"key":"1566_CR1","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S1470-2045(06)70616-7","volume":"7","author":"ND Futran","year":"2006","unstructured":"Futran ND, Mendez E (2006) Developments in reconstruction of midface and maxilla. 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Approval was granted by the Institutional Review Board of the Charit\u00e9 Universit\u00e4tsmedizin Berlin, Germany (02\/23\/2023\/EA2\/030\/23).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the images used in this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"Max Heiland declares a speaker honorarium from KLS Martin and Materialise as well as research funding from KLS Martin.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"80"}}