The detailed surgical technique for harvesting the composite full-face flap was described in the related literature (Figs. 34.2 and 34.3) [1]. Herein, only a brief description of the surgical technique is presented. First, a circular neck incision was made anteriorly and posteriorly. Then, elliptical incisions were made around the eyes and, finally, perioral incisions were made. The flap was started so that it was elevated above the plane of the facial muscles. In the neck region, the submandibular gland and posterior belly of the digastric muscle were removed, and the greater horn of the hyoid bone was divided. The carotid sheath was explored, and the internal carotid artery was ligated and divided at its origin from the common carotid artery. The external carotid artery was dissected up to its bifurcation into the facial and superficial temporal arteries following ligation of the occipital, superior thyroid, and lingual branches. The external jugular vein was dissected following ligation of the anterior facial vein branches [1].

The posterior auricular artery and superficial temporal artery were preserved, but the internal maxillary artery was transected. The external auricular canal was detached from its bony insertion and the ear was included in the composite fascial flap. Then, to maintain adequate lengths of the pedicles, the facial-scalp flap was harvested based on the bilateral common carotid arteries and external jugular veins (Fig. 34.3) [1].

In the recipient rats, similar incisions as described for the donors were made, and the entire face and scalp tissues, except the perinasal, perioral and periorbital tissues, were removed and a defect was created (Fig. 34.4). Different recipient vessels, including the common carotid artery, external jugular vein, external carotid artery, anterior facial vein, and facial artery, were prepared for the anastomosis [1].