Reconstruction of Extensive Composite Oromandibular Defects with Simultaneous Free Anterolateral Thigh Fasciocutaneous and Fibular Osteocutaneous Flaps

Abstract

Massive composite defects of the face are difficult to reconstruct. Such defects are usually created after ablation of advanced cancers of the head and neck region. The use of a free fibular osteocutaneous flap for the bone and mucosal lining of the oral cavity and anterolateral thigh flap for the outer cutaneous lining are well established. We present our experience of using these two flaps simultaneously in the reconstruction of such defects and to evaluate the outcome. There were a total of 10 patients in our study. Their average age was 48.8 years. All had squamous cell carcinoma of the oral cavity. Their pathological stages were mostly stage T4 with only one case being T3. Flap survival was 100%. The application of dual free flaps, though technically more demanding, allows good orientation of the flaps. Seven patients maintained a good functional outcome. They were able to eat a soft diet. Their speech was easily comprehensible. The combination of a free anterolateral thigh flap with vascularized fibular osteocutaneous flap can be performed safely with adequate functional outcome. This combination of flaps should be considered for this group of patients.

Chimeric vs composite flaps for mandible reconstruction

“…The range of surface area covered in the intrinsic chimeric flaps was 5‐390 cm (average 135 cm 2 ), whereas for our 2 flap cases the range was 225‐500 cm 2 (average 350 cm 2 ). Some previous literature on 2 free flap reconstruction reflects this; however, many series report 2 flap reconstruction of smaller defects or do not report soft tissue surface area …”

Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects

“…Both treatment approaches can be followed and used in the sandwich technique whenever they are appropriate and indicated (Lee et al 2010).…”

Reconstruction of Through-and-through Oromandibular Defect: Comparison of Four Different Techniques

“…4–6 The fibular OSC flap’s excellent bone quality allows osseointegrated implants for dental restoration while sufficient length is obtainable to replace the entire mandible if necessary. 7 In addition, the donor-site morbidity is limited and well tolerated. The fibular flap, however, also has distinct disadvantages, as its most glaring shortcoming is its lack of soft-tissue volume.…”

“…Although the skin paddle of the fibular flap is adequate enough to provide an inner and outer lining, its lack of soft tissue prevents it from filling up the dead space that results from the extirpated masticator muscles, buccal fat, and parotid gland. 7 This dead space may lead to fluid accumulation that could cause secondary infection and an unfavorable cosmetic appearance along with further functional difficulties in swallowing, chewing, and speech. In addition, the fibular flaps require longer operation hours due to difficulties in harvesting and inset.…”

“…The adequate soft-tissue bulk of the ALT flap is also required to prevent subsequent bone and plate exposure. 7 Although ALT flaps provide greater soft-tissue volumes and are easier to harvest and inset when compared with the fibular osteocutaneous flap, their lack of a bone component that leads to the necessity of reconstruction plates should also be taken into consideration.…”