About Prof. Li Qingfeng
Prof. Li Qingfeng is a renowned plastic and reconstructive surgeon at the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine — one of China's foremost centres for craniofacial surgery, microsurgery, and complex reconstructive procedures. He specialises in craniofacial reconstruction, microsurgery, and complex wound repair, and is widely regarded as one of Asia's leading reconstructive surgeons. His team has pioneered autologous total facial prefabrication reconstruction — a technique described by international peers as "the most breakthrough innovative approach since the new millennium" and recognised globally as a landmark contribution to facial reconstruction. His research programme has also advanced stem cell-mediated skin stretch regeneration, enabling large-area skin defect repair without donor site morbidity. His clinical philosophy holds that the goal of reconstructive surgery is not simply wound closure — it is the restoration of the patient's face, function, and identity; and that achieving this requires not only surgical innovation but the courage to pursue solutions that do not yet exist in the textbook.
Case Overview
Mr. Huang (pseudonym), a 34-year-old man, sustained severe full-thickness burns to his entire face, scalp, and anterior neck in an industrial accident involving a chemical fire. He underwent emergency debridement and split-thickness skin grafting at the referring hospital, which achieved wound closure but left him with extensive hypertrophic scarring, severe contracture of the eyelids and mouth, loss of nasal structure, and a facial appearance that was profoundly disfiguring and functionally limiting — with restricted mouth opening, lagophthalmos, and inability to close his lips. Over the following two years he underwent multiple revision procedures at several institutions without achieving satisfactory functional or aesthetic restoration. He was referred to Prof. Li Qingfeng at the Ninth People's Hospital. Following comprehensive assessment — including three-dimensional facial imaging, vascular mapping of the chest wall, and multidisciplinary planning with anaesthesiology and intensive care — Prof. Li's team proposed autologous total facial prefabrication reconstruction: a staged procedure in which a complete facial cover, vascularised and shaped to match Mr. Huang's facial anatomy, would be grown from his own tissue on the anterior chest wall over six to eight months before transfer to the face. The prefabricated facial unit was transferred as a free flap with microsurgical anastomosis. The result was a reconstructed face with natural contour, skin colour and texture closely matched to the patient's original complexion, restored eyelid and lip function, and natural facial expression — without the need for lifelong immunosuppression. Mr. Huang reflected: "I had been told there was nothing more that could be done. Prof. Li's team gave me back my face — and with it, my life. I can look at myself in the mirror again."
Diagnostic Workup
Three-dimensional facial surface imaging and CT craniofacial reconstruction characterised the extent of scarring, contracture, and structural loss — providing the anatomical template for prefabrication planning and three-dimensional tissue simulation. Vascular mapping of the anterior chest wall using CT angiography identified the internal mammary perforator vessels as the vascular pedicle for prefabrication, confirming adequate vessel calibre and distribution for the planned tissue expansion and prefabrication procedure. Functional assessment quantified the degree of lagophthalmos, mouth opening restriction, and lip incompetence, establishing the functional targets for reconstruction. Skin colour and texture analysis of the chest wall donor site confirmed suitability for facial colour matching. Multidisciplinary planning — plastic surgery, anaesthesiology, intensive care, and ophthalmology — established the staged surgical plan, anaesthetic strategy for prolonged microsurgical procedures, and postoperative monitoring protocol.
Prof. Li's pre-operative assessment: The conventional reconstructive options — local flaps, skin grafts, tissue expansion — have been exhausted in this patient, and none of them can address the full extent of the facial defect. What this patient needs is a complete facial cover: a single unit of vascularised autologous tissue that matches his skin colour and texture, can be shaped to his facial anatomy before transfer, and will restore not just wound coverage but facial contour, expression, and function. The prefabrication approach gives us the time to grow that tissue, shape it, and vascularise it before we transfer it — so that when it arrives on the face, it is already a face.
Treatment Strategy and Course
Diagnosis: Severe Full-Face Post-Burn Scarring and Contracture with Functional Impairment (Lagophthalmos, Microstomia, Lip Incompetence) and Complete Aesthetic Disfigurement following industrial chemical burn, after exhaustion of conventional reconstructive options.
Treatment principle: autologous total facial prefabrication reconstruction — a staged procedure growing a complete vascularised facial cover from the patient's own chest wall tissue, shaped to three-dimensional facial anatomy before transfer, and transferred as a free flap with microsurgical anastomosis — restoring facial contour, skin quality, and function without immunosuppression.
- Stage 1 — Tissue expansion and prefabrication initiation (Months 1–2): Tissue expanders placed beneath the anterior chest wall skin overlying the internal mammary perforators; serial expansion over eight weeks to generate sufficient skin surface area for full facial coverage; stem cell injection at the expansion interface to enhance skin regeneration capacity and improve tissue quality during stretch
- Stage 2 — Three-dimensional prefabrication and vascularisation (Months 3–6): Expanded chest skin elevated as a perforator flap; three-dimensional facial template — derived from CT craniofacial reconstruction and mirrored from pre-injury photographs — used to shape the flap into nasal, periorbital, and perioral subunits; cartilage framework for nasal reconstruction incorporated; flap returned to chest wall for in situ vascularisation over twelve weeks; serial imaging confirmed progressive vascularisation of the prefabricated facial unit
- Stage 3 — Free flap transfer and microsurgical anastomosis (Month 7): Prefabricated facial unit elevated as a free flap on the internal mammary perforator pedicle; recipient vessels prepared in the face and neck; microsurgical anastomosis of artery and vein under operating microscope; flap inset to cover the entire facial surface; total operative time approximately 14 hours; flap perfusion confirmed intraoperatively and monitored continuously postoperatively
- Postoperative course: Flap viability maintained throughout; no vascular compromise; oedema resolved over six weeks; eyelid and lip function assessed at eight weeks — lagophthalmos resolved, mouth opening improved to 38 mm, lip competence restored; skin colour and texture integration with surrounding tissue excellent
- Long-term outcome (12 months post-transfer): Natural facial contour restored; skin colour and texture closely matched to original complexion; facial expression present and natural; no immunosuppression required; patient returned to social and professional life; psychological assessment confirmed significant improvement in self-image and quality of life
Prof. Li's clinical reflection: The prefabrication approach requires patience — from the surgeon and from the patient. Six to eight months of preparation before the transfer procedure is a long time. But the result is qualitatively different from anything that can be achieved with conventional techniques: a face that is the patient's own tissue, shaped before it arrives, vascularised and ready to integrate. The stem cell enhancement of the expansion phase is what allows us to generate the skin quality we need — not just the surface area. Mr. Huang's outcome is what this technique was designed to achieve.
Expert Commentary — Prof. Li Qingfeng
1. Autologous Total Facial Prefabrication Reconstruction: Principles, Innovation, and Advantages Over Face Transplantation
Total facial reconstruction following severe disfigurement presents one of the most demanding challenges in reconstructive surgery. Face transplantation — the transfer of a facial allograft from a deceased donor — has been performed in a small number of centres globally and can achieve remarkable aesthetic and functional results. However, it requires lifelong immunosuppression with its attendant risks of infection, malignancy, and metabolic complications; it is dependent on donor availability; and it carries the psychological complexity of living with another person's face. Autologous total facial prefabrication reconstruction, pioneered by Prof. Li Qingfeng's team, offers an alternative that avoids these limitations entirely. By growing a complete facial cover from the patient's own tissue — using the anterior chest wall as the prefabrication site, the internal mammary perforators as the vascular pedicle, and three-dimensional simulation to shape the tissue before transfer — the technique achieves facial reconstruction with autologous tissue that requires no immunosuppression, carries no risk of rejection, and produces skin colour and texture that closely matches the patient's original complexion. The technique has been applied to hundreds of patients with severe facial disfigurement and has been recognised internationally as a landmark innovation in reconstructive surgery.
2. Stem Cell-Mediated Skin Stretch Regeneration: From "Robbing Peter to Pay Paul" to Activating Intrinsic Regenerative Potential
Conventional skin reconstruction relies on the transfer of skin from one part of the body to another — a paradigm that inevitably creates a donor site defect in exchange for recipient site coverage. Prof. Li Qingfeng's team has developed a fundamentally different approach: stem cell-mediated skin stretch regeneration, in which the injection of stem cells at the interface of mechanically stretched skin dramatically enhances the skin's capacity to expand and regenerate in response to sustained, gentle traction. The biological mechanism involves stem cell activation of the skin's intrinsic regenerative pathways — stimulating keratinocyte proliferation, dermal fibroblast activity, and angiogenesis in the expanding tissue. The clinical result is the generation of new skin — with normal colour, texture, and appendages — without donor site morbidity. Research from Prof. Li's group, published in Advanced Science, has characterised the cellular and molecular mechanisms underlying this regenerative response and demonstrated its clinical efficacy in large-area skin defects and chronic wounds. The conceptual shift — from surgical redistribution of existing skin to activation of the body's own regenerative capacity — represents a meaningful advance in reconstructive thinking.
3. Microsurgery and Free Flap Transfer in Complex Facial Reconstruction: Technical Precision and Perioperative Management
The transfer of a prefabricated facial unit as a free flap — with microsurgical anastomosis of vessels measuring 1–3 mm in diameter under operating microscope magnification — is the technical centrepiece of the reconstruction and the step on which the entire outcome depends. Free flap success rates in experienced microsurgical centres exceed 95%, but the complexity of facial free flap transfer — with its large surface area, multiple subunit insets, and the physiological demands of a 12–16 hour procedure — requires meticulous perioperative management as well as surgical precision. Anaesthetic management must maintain haemodynamic stability and optimal tissue perfusion throughout a prolonged procedure. Postoperative flap monitoring — clinical assessment of colour, turgor, and capillary refill, supplemented by implantable Doppler monitoring of the anastomotic vessels — must be continuous for the first 72 hours, when the risk of vascular compromise is highest. The multidisciplinary team — plastic surgery, anaesthesiology, intensive care, and nursing — is as important to the outcome as the microsurgical technique itself.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Mr. Huang and his family throughout the multi-stage reconstructive pathway at the Ninth People's Hospital, Shanghai Jiao Tong University, including: priority consultation coordination with Prof. Li Qingfeng's reconstructive surgery team; bilingual interpretation across all surgical planning consultations, staged procedure discussions, and follow-up appointments; bilingual explanation of the autologous facial prefabrication technique, the staged surgical plan, the stem cell-enhanced expansion protocol, and the microsurgical transfer procedure; coordination of three-dimensional facial imaging, CT angiography, and functional assessments with bilingual results communication; bilingual consent for each surgical stage; intraoperative family liaison and postoperative intensive care coordination including flap monitoring updates; coordination of postoperative rehabilitation including eyelid and lip function assessment, psychological support referral, and long-term surveillance scheduling; and bilingual communication of all follow-up results and functional recovery milestones.
For international patients facing severe facial disfigurement — from burns, trauma, tumour resection, or congenital conditions — Prof. Li Qingfeng's team at the Ninth People's Hospital offers access to one of the world's most innovative and experienced facial reconstruction programmes. CMCS ensures that expertise is accessible — in the patient's language, with every step coordinated and communicated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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