The zygomatic implant perforated flap in the reconstruction and early rehabilitation of low-level maxillectomies: A technical note.

The "Zygomatic Implant Perforated Flap" (ZIP flap) technique, first described by Butterworth in 2017, combines the closure of bucco-sinusal or bucco-nasal communications using a fasciocutaneous free flap with early implant-based prosthetic rehabilitation via zygomatic implants that perforate the flap. This approach enables rapid dental rehabilitation within weeks of tumor resection, promoting early recovery of oral function. We present the case of a 49-year-old male who underwent delayed ZIP flap reconstruction one year after maxillectomy and radiotherapy. Four zygomatic implants were placed using a surgical guide, followed by inset of a radial forearm free flap perforated over each implant emergence. A prefabricated transitional prosthesis was immediately screwed onto the implants. This technical note highlights the advantages of the ZIP flap in reconstructing Brown Class II maxillectomy defects, offering reduced rehabilitation time, improved prosthesis retention, and enhanced functional and psychological outcomes.