Maxillofacial trauma caused by severe ballistic or avulsion injuries to the face creates complex composite defects. The essential difference between most blunt facial injuries and ballistic or avulsive facial injuries is the severity of the soft and hard tissue loss and damage. Application of modern principles of fracture management and wound care, however, allows restoration of the facial framework until a healthy tissue bed is achieved for definitive repair. Free tissue transfer has made it possible to bring well-vascularized bone and soft tissue into a hostile wound environment with excellent survival of the flap tissues. This has allowed for simultaneous reconstruction of the bony facial skeleton and the overlying soft tissue soon after injury.