Soft-tissue Transfer in the Setting of Failed Facial Reconstruction: Further Application of the Sandwich Flap

Summary: There is a broad consensus among plastic surgeons that extensive full-thickness facial defects are most effectively managed using free tissue transfer. In the context of substantial facial defects, microsurgical techniques represent the gold standard for achieving optimal aesthetic and functional outcomes. Nevertheless, free flap failure remains a potential complication, independent of surgical expertise. In such cases, salvage options are notably constrained. We have developed an innovative adaptation using 2 well-established surgical procedures—the supraclavicular and submental flaps—initially designed for the rescue of nasal reconstructions. The ease of execution and reliability of this technique have encouraged its application to other aesthetic units. The clinical indications and physiological rationale for this are presented herein, within the context of salvaging previously unsuccessful reconstructive procedures.