Midfacial radiation-induced defects usually involve the bony structures and require composite reconstruction. A 36-year-old male patient with a midfacial defect due to radiation and failure of local flaps was referred to us and treated successfully with a microvascular flap. This case is reported in correspondence with a literature review of the classification of midfacial defects, choice of treatments, and outcomes of different reconstructive options. The deleterious effects of radiation on tissue healing and the functional and aesthetic outcome of reconstruction are discussed. Midfacial defects that are refractory to treatment with local flaps are best treated with microvascular free tissue transfer
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