Free Combined Anterolateral Thigh Flap and Vascularized Fibula for wide, through-and-through Oromandibular Defects

Abstract

Through-and-through oromandibular defects require the greatest amount of soft-tissue volume among the transfers for head and neck defects. A new method, a large anterolateral thigh flap combined with a vascularized fibula graft in a chimera fashion, has been used for two patients with wide through-and-through oromandibular defects. Among the candidates for such a large skin flap, the anterolateral thigh flap seems to be the best, for the following reasons. (1) Its pedicle, the lateral circumflex femoral system, has several major branches of equal size of anastomosis of the peroneal vessels. (2) As the majority of such patients with multiple previous surgery have lost recipient vessels near the mandible, the longest vascular pedicle is required. (3) There is no need for positional changes, and simultaneous flap elevation with the tumor resectioning is possible. (4) Use of the fibula allows for reconstruction of the entire mandible, if necessary. (5) Some of the shortcomings of individual donor sites for massive composite osteocutaneous flaps are minimized, because each component consists of two donor sites. (6) Operating time for this flap elevation is minimized, compared to that for massive composite osteocutaneous flaps, because the individual components can be obtained simultaneously by two teams.

Rapid autonomisation of a combined fibular‐ and anterolateral thigh flap transferred by a wrist carrier to an irradiated and vessel depleted neck

“…Moreover, two large flaps were necessary for reconstruction, because of the huge composite defect of the lower face. Following the chimeric flap principle described by other authors [13,14] the anterolateral thigh combined with the osteocutaneous fibular flap were used, which were both chain linked to the radial artery and cephalic vein. This technique of a free flap carrier was first described by Taylor et al in 1979 and mainly used for reconstructive procedures on the trunk and the extremities, when the recipient site showed poor vascularisation [15][16][17][18][19].…”

Reconstruction of lateral through and through oro‐mandibular defects following oncological resections

“…The study population consisted of 24 males (57.1%) and 18 females (42.9%), ranging in age from 25 to 81 years (mean, 62.6 years). The primary location of the tumor was the mandibular alveolar crest (18 cases), retromolar trigon (9), floor of the mouth (8), cheek (5), and oral commissure (2). For reconstruction a single free flap technique was used eight times; a double free flap technique, seven times; free and locoregional flap association, 25 times; and a single locoregional flap and two associated locoregional flaps, one time each.…”

“…1 Koshima et al in 1998 reported their experience with a free combined anterolateral thigh flap and vascularized fibula for wide through and through oromandibular defects. 2 Takushima et al in 2001 proposed an algorithm for mandibular defects reconstruction using a single free flap, proposing for the lateral through and through ones the use of free scapula osteocutaneous flap, associated to a second free flap only in case of extensive soft tissue resection. 3 Deleyiannis et al in 2006 proposed the employment of the free radial forearm osteocutaneous flap, associated to a locoregional flap in case of large skin resections, 4 while Gal et al in 2009 emphasized the use of the free fibula osteocutaneous flap.…”

Central arch mandibular reconstruction after surgery of oral carcinoma: an observational experience at MDACC, Houston, Texas, USA

“…12 For through and through large oromandibular defects which may require a large skin flap in addition to the bone and mucosal lining repair, the anterolateral thigh flap seems to be best for many reasons. 13 Alternatively the radial forearm flap and the rectus abdominis myocutaneous flap can be used but they have some disadvantages that restrict their use for this purpose. The forearm flap is usually too thin to cover the fibular bone and reconstruction plate and the rectus abdominis myocutaneous flap can cause a sub-clinical reduction in abdominal strength.…”