Enormous oromandibular defects in children remain a reconstructive challenge due to the region's unique features and the scarcity of a perfectly matched recipient site. The osteocutaneous fibula-free flap (OCFFF) is an excellent option for these defects. Most reports on oromandibular reconstruction in children are limited to surgical techniques instead of long-term follow-up, especially in resource-limited settings. We reported a 9-year-old child who presented with a massive oromandibular defect caused by a high-energy gunshot. Firstly, the patient was treated with debridement, lower defect edges approximation, and tracheostomy. After one week, the procedure of OCFFF was performed, and two months later, the lower lip was reconstructed using a tongue flap. The aesthetic outcome was excellent at two years, and the patient could speak and eat without impaired oral function. In conclusion, microsurgical reconstruction using OCFFF for massive oromandibular defects in our child patient was safe with satisfactory facial aesthetics and oral function.

Introduction while reconstruction of complex wounds with severe tissue defects has been a significant problem in plastic surgery, free flap microsurgical procedures could solve many of these problems. In Yemen, data regarding free flap microsurgery for complex wounds are scarce. This study aimed to share our microsurgery experiences in repairing complex wounds using different free flaps in a resource-limited setting. Methods a retrospective cross-sectional study between April 2019 and June 2022 conducted at 21 University-affiliated hospitals included 30 patients with complex wound defects that were not amenable for regional, pedicle procedures, or skin grafts and underwent microsurgical reconstructions with deferent free flap tissue transfer. The primary outcome was flap survival or failure, while the secondary outcome was postoperative complications. Results the main age was 34.76 ± 16.88 years, with 24 (80%) males and 6 (20%) females. Replacing extensive tissue loss caused by road traffic accidents was the most common indication (36.6%). The mean defects required to be reconstructed were 84.9 ± 44.70 cm 2 . The lower extremities accounted for the majority of reconstructed defects (50%), and mostly (23.3%) involved the leg. Only 10 (33.3%) flaps were performed immediately within 48 hours of trauma. The fibulae osteo-cutaneous free flap (30.0%), radial forearms free flap (23.3%), and anterolateral thigh flap (23.3%) were used most commonly. All flaps were harvested and repaired under loupe magnification or operative microscope by a single surgeon. The overall flap success rate was 83.3%. The total complication rate was 23.3%, and postoperative infection and partial flap necrosis occurred in 3 (10.0%) and 2 (6.6%) patients, respectively. A total flap loss occurred in 5 (16.7%) patients. Conclusion reconstruction of complex wounds with microsurgical free flaps is a viable option even in a resource-limited setting. In our study, microsurgery with fibulae osteo-cutaneous free flap was the most commonly used. Despite many limitations, microsurgical free flaps were effective in treating individuals operated on in our setup with a limb salvage rate of 83.3%.