Objective: Through and through defect is very specific in maxillofacial area causing serious damage and reduce quality of patients' life. This study represent the clinical characteristics of maxillofacial through and through defect and access the out come of treatment these defects by free flaps. Patients and methods: 16 patients with maxillofacial through and through defect were treated by surgical management, using 19 fibular, ALT, scapular - Para scapular free flaps. Results: 9/16 patients suffered from post radiation therapy necrosis, 5/6 caused by cancer and the rest were infectious complication. 18/19 free flaps survived totally, excellent outcome gained with 12/16 patients in sort-term and 7/11 patients in long-term following. 1/19 flaps necrosis caused by vascular thrombosis, wound fistula happened in 3/16 cases mainly related to the post radiation therapy necrosis group. Conclusions: Through and through defect in maxillofacial area is very complicated and difficult to treat. Free flap using bring high rate of excellent outcome and considered as the best of choice for reconstruction the defect in the medical units which has microsurgery.
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