A composite tissue allotransplantation of the total face along with the scalp and the auricles is technically feasible. The authors' flap provided reliable vascularization and was obtained in a standardized fashion in less than 11 hours. The graft contained all of the perioral muscles, branches of the facial nerve, eyelid structures, and major salivary glands.

These findings suggest that when an additional venous outflow is required, the use of the IMV retrograde limb may help to avoid flap venous congestion. © 2016 Wiley Periodicals, Inc. Microsurgery 36:447-452, 2016.