{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T11:14:06Z","timestamp":1772450046840,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: 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. Methods: 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\u2013Whitney U test. Results: 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 (p = 0.004), change in appearance (p = 0.022), sensation (p = 0.011), and social activity (p = 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. Conclusions: Chimeric free flaps represent a feasible reconstructive option in selected cases of complex maxillary and midface reconstruction. Their main advantages\u2014providing the proper amount of specific, well-vascularized tissue and offering greater mobility of components\u2014 may be associated with more favorable functional, aesthetic, and social outcomes in unadjusted comparisons compared to reconstruction using single free flaps.<\/jats:p>","DOI":"10.3390\/jcm15051866","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"1866","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Functional and Aesthetic Outcomes of Chimeric vs. Single Free Flaps in Midface Reconstruction Following Tumor Resection: A Retrospective Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6593-3384","authenticated-orcid":false,"given":"Daniel","family":"Bula","sequence":"first","affiliation":[{"name":"1st Department of Oncological Surgery with Subunit of Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakub","family":"Opyrcha\u0142","sequence":"additional","affiliation":[{"name":"2nd Department of Oncological Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-5651","authenticated-orcid":false,"given":"\u0141ukasz","family":"Krakowczyk","sequence":"additional","affiliation":[{"name":"1st Department of Oncological Surgery with Subunit of Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Maciejewski","sequence":"additional","affiliation":[{"name":"1st Department of Oncological Surgery with Subunit of Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Walczak","sequence":"additional","affiliation":[{"name":"1st Department of Oncological Surgery with Subunit of Reconstructive and Plastic Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, 44-102 Gliwice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00006534-199402000-00008","article-title":"Three-dimensional folded free-flap reconstruction of complex facial defects using intraoperative modeling","volume":"93","author":"Pribaz","year":"1994","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/BF00178737","article-title":"Reconstruction of maxillary and palatal defects with the free radial forearm free flap","volume":"18","author":"Rollon","year":"1995","journal-title":"Eur. J. Plast. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/hed.10366","article-title":"Surgical management of maxillectomy defects based on the concept of buttress reconstruction","volume":"12","author":"Yamamoto","year":"2004","journal-title":"Head Neck"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/(SICI)1097-0347(199609\/10)18:5<412::AID-HED4>3.0.CO;2-8","article-title":"Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect","volume":"18","author":"Brown","year":"1996","journal-title":"Head Neck"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/hed.2880120502","article-title":"Reconstruction of complex maxillectomy defects with the scapular free flap","volume":"12","author":"Granick","year":"1990","journal-title":"Head Neck"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1097\/00006534-199309000-00004","article-title":"Free combined composite flaps using the lateral femoral system for repair of massive defects of the head and neck regions: An introduction to the chimeric flap principle","volume":"92","author":"Koshima","year":"1993","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1097\/00006534-200006000-00004","article-title":"A classification system and algorithm for reconstruction of maxillectomy and midfacial defects","volume":"105","author":"Cordeiro","year":"2000","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/S0002-9610(05)80553-7","article-title":"Sequential connection of flaps: A logic approach to customized mandibular reconstruction","volume":"160","author":"Sanger","year":"1990","journal-title":"Am. J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/00006534-198211000-00020","article-title":"A free transfer of both latissimus dorsi and serratus anterior flaps with thoracodorsal vessel anastomoses","volume":"70","author":"Harii","year":"1982","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/00000637-198811000-00015","article-title":"The free or pedicled anteromedial thigh flap","volume":"21","author":"Koshima","year":"1988","journal-title":"Ann. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00000637-199108000-00006","article-title":"Simultaneous transposition of anterior thigh muscle and fascia flaps: An introduction to the chimera flap principle","volume":"27","author":"Hallock","year":"1991","journal-title":"Ann. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1177\/0194599819844997","article-title":"Complications and outcomes of chimeric free flaps: A systematic review","volume":"161","author":"Ettyreddy","year":"2019","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1002\/ohn.922","article-title":"Chimeric versus multiple simultaneous free flaps for head and neck reconstruction","volume":"171","author":"Wang","year":"2024","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4196","DOI":"10.1002\/lary.31466","article-title":"Chimeric versus multiple flaps for composite oral cavity defects: A systematic review and meta-analysis","volume":"134","author":"Punjabi","year":"2024","journal-title":"Laryngoscope"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.fsc.2024.07.004","article-title":"Advances in midface reconstruction","volume":"33","author":"Strohl","year":"2025","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1097\/00006534-199811000-00011","article-title":"Reconstruction of total maxillectomy defects with preservation of the orbital contents","volume":"102","author":"Cordeiro","year":"1998","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1001\/archoto.2010.32","article-title":"The Physical Function and Social-Emotional Function subscales of the University of Washington Quality of Life Questionnaire","volume":"136","author":"Rogers","year":"2010","journal-title":"Arch. Otolaryngol. Head Neck Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e5194","DOI":"10.1097\/GOX.0000000000005194","article-title":"Mid-face massive loss reconstruction: Free latissimus dorsi used as both a donor and recipient for two subsequent temporoparietal flaps","volume":"11","year":"2023","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/(SICI)1098-2752(1998)18:3<148::AID-MICR2>3.0.CO;2-H","article-title":"Three-dimensional reconstruction of types IV and V midfacial defects by free rectus abdominis myocutaneous flap","volume":"18","year":"1998","journal-title":"Microsurgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/S1470-2045(10)70113-3","article-title":"Reconstruction of the maxilla and midface: Introducing a new classification","volume":"11","author":"Brown","year":"2010","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/00006534-198604000-00003","article-title":"The osteocutaneous scapular flap for mandibular and maxillary reconstruction","volume":"77","author":"Swartz","year":"1986","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00006534-199307000-00022","article-title":"Simultaneous maxillary and mandibular reconstruction with one free osteocutaneous flap","volume":"92","author":"Sadove","year":"1993","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S1470-2045(06)70616-7","article-title":"Developments in reconstruction of midface and maxilla","volume":"7","author":"Futran","year":"2006","journal-title":"Lancet Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.otc.2023.04.010","article-title":"History, innovation, pearls, and pitfalls in complex midface reconstruction","volume":"56","author":"McCrary","year":"2023","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"104508","DOI":"10.1016\/j.oraloncology.2019.104508","article-title":"Virtual surgical planning in subscapular system free flap reconstruction of midface defects","volume":"101","author":"Swendseid","year":"2020","journal-title":"Oral Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kang, Y.-F., Lv, X.-M., Qiu, S.-Y., Ding, M.-K., Xie, S., Zhang, L., Cai, Z.-G., and Shan, X.-F. (2021). Virtual surgical planning of deep circumflex iliac artery flap for midface reconstruction. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.718146"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Bula, D., Opyrcha\u0142, J., Walczak, D., Krakowczyk, \u0141., and Maciejewski, A. (2025). Identifying high-risk patients with advanced midface cancer: Personalized surgical and reconstructive approach for radical resection. Cancers, 17.","DOI":"10.3390\/cancers17040585"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.fsc.2016.06.012","article-title":"The evolution of complex microsurgical midface reconstruction: A classification scheme and reconstructive algorithm","volume":"24","author":"Alam","year":"2016","journal-title":"Facial Plast. Surg. Clin. N. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1002\/jso.24150","article-title":"State-of-the-art reconstruction of midface and facial deformities","volume":"113","author":"Chang","year":"2016","journal-title":"J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1016\/j.bjps.2014.12.002","article-title":"Microsurgical reconstruction of the maxilla: Algorithm and concepts","volume":"68","author":"Costa","year":"2015","journal-title":"J. Plast. Reconstr. 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