Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects

Lateral composite mandibular defects resulting from excision of advanced or al carcinoma often require mandible, intra-oral lining, external face, and soft-tissue bulk reconstruction. Ignorance of importance soft-tissue defici t in those patients may cause significant morbidity and functional loss. Su ch defects, therefore, can be reconstructed best with a double free nap tec hnique. However, this procedure may not be feasible for every patient or su rgeon. An alternative procedure is a free fibula osteoseptocutaneous flap c ombined with a pedicled pectoralis major myocutaneous flap. This combinatio n was used in reconstruction of extensive composite mandibular defects in 1 4 patients with T3/T4 oral squamous cell carcinoma. All patients were men, and the average age was 54.3 years. The septocutaneous paddle of the fibula flap was used for the mucosal lining of the defects while the bony part es tablished the rigid mandibular continuity. The pectoralis major nap then co vered the external skin defect in the face and check, and the dead spaces l eft by the extirpated masticator muscles, buccal fat, and parotid gland. On e free fibula flap failed totally, and one pectoralis major flap dal-eloped marginal necrosis. At the time of final evaluation, nine patients (64.3 pe rcent) were alive, surviving an average of 25.7 months. All patients eventu ally regained their oral continence and an acceptable cosmetic appearance. In conclusion, the fibula osteoseptocutaneous flap pills regional myocutane ous flap choice is a successful and technically less demanding alternative to the double free flap procedures in reconstruction of extensive lateral m andibular defects.