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This patient had had a hemimandibulectomy after excision of a carcinoma of the floor of the mouth and radiation treatment. Occlusion of the remaining mandible was good and excursion and mastication were possible. A vascularized dermofat graft from the groin area was used to restore contour, the principal defect in this case. (From Alpert, B.S., Gordon, L., and Buncke H.J.: The groin flap. In Symposium on Clinical Frontiers in Reconstructive Microsurgery. Vol. 24. Edited by H.J. Buncke and D.W. Furnas, St. Louis, C.V. Mosby, 1984.)
 FIG. 6-10. Loss of contour of the right side of the mandible because of the removal of the ramus and the body up to the symphysis.
 FIG. 6-11. The flap is elevated on its pedicle and the vessels are then transected.
 FIG. 6-12. The skin is removed from the groin flap with the Humby knife down to the deeper layers of the dermis. The level must be just above the subcutaneous fat to remove hair follicles and other structures that cause cysts and hair balls if left behind.
 FIG. 6-13. The dermofat graft, folded at its lower margin to simulate the angle of the mandible, is ready for insertion into the large pocket of the entire right cheek.
 FIG. 6-14. The appearance of the face after two subsequent defatting and contouring procedures. Unlike nonvasularized dermofat grafts, this graft has little or no shrinkage, and over-correction should be avoided.
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 FIG. 6-15. The scar is well hidden along the restored mandibular margin.
CASE 3
This is a case of Romberg's disease with almost total hemifacial atrophy. The dermofat graft groin flap was selected here over the omentum, which tends to sag.
 FIG. 6-16. Atrophy of the periorbital structures, malar region, upper and lower lip, and chin, and to a lesser extent, the forehead.
 FIG. 6-17. The groin flap, partly de-epithelialized, is in place over the cheek. Anastomoses were performed between the superficial temporal vessels and those to the groin flap.
 FIG. 6-18. To prevent sag, the dermis is inset with tie-over bolsters and placed next to the deep wound surface.
 FIG. 6-19. Restoration of fullness in the entire cheek area and around the upper and lower lip and mouth. The vermilion was thin. This was partially corrected by a longitudinal 180-degree vermilion rotation flap from the normal side.
CASE 4
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