COMBINED ANTERIOR THIGH FLAPS AND VASCULARIZED FIBULAR GRAFT FOR RECONSTRUCTION OF MASSIVE COMPOSITE OROMANDIBULAR DEFECTS

Six massive, composite oromandibular defects were reconstructed using combined anterior (anterolateral and anteromedial) thigh flaps and vas cularised fibular graft in bridge or chimeric fashion. Except for mino r dehiscence in one case and infection in another, all flaps survived without complication. Anterior thigh flaps provide large-calibre, long vascular pedicles while derivative branches from the lateral circumfl ex femoral system facilitate simultaneous transplantation of multiple components. Because the pedicle of the vascularised fibular graft is o f insufficient length, the lateral circumflex femoral vessels provide a remote vascular source as a flow-through vascular conduit. A combine d flap using the lateral circumflex femoral system is considered to be most suitable for reconstruction of through-and-through defects of th e head and neck. The authors describe the advantages of this method an d the detailed anatomy of the cutaneous perforators of the anterior th igh flaps.