Functional oromandibular reconstruction using a sternum pectoralis major osteomyoctaneous composite flap

Segmental mandibular reconstruction in patients with poor lower extremity perfusion, vessel-depleted necks and/or profound medical frailty

“…Moreover, this technique is not advised in multisegment and/or anterior/symphyseal defects due to unacceptable cosmetic and functional results [13,89]. The native mandibular contour, facial cosmesis and residual postablative Pedicled osseous mandibular reconstructions have also been described, predominantly in publications from decades ago and/or outside of the North American literature [92][93][94][95][96][97], with varying degrees of success. The pectoralis major osteomyocutaneous flap (PM-OMC) has been well described historically as a pedicled mandibular reconstructive alternative.…”

“…risk of developing an 'Andy Gump' deformity) with long-term follow-up [101]. Other less common regional pedicled osseous flaps employed for reconstructing the mandible include pectoralis with sternum or clavicle [92,93], rectus abdominis muscle with rib based on the internal mammary artery [97], pedicled latissimus-serratus-rib flap [102], sternocleidomastoid muscle with clavicle [94], and osteomuscular dorsal scapular (OMDS) flap, which includes medial scapular border and trapezius with scapular spine based on the transverse cervical vessels [95,96,103] (Table 3). Currently, unpredictable outcomes of pedicled mandibular reconstructions combined with the contemporary acceptance of osseous free flaps as the unequivocal gold standard have largely relegated PM-OMC and other pedicled osseous mandibular reconstructions as obsolete.…”

“…A major drawback of distraction includes slow distraction (1 mm per day or less) leading to protracted external appliance placement [4 ▪▪ ,36,37]. Pedicled osseous mandibular reconstructions have also been described, predominantly in publications from decades ago and/or outside of the North American literature [92–97], with varying degrees of success. The pectoralis major osteomyocutaneous flap (PM-OMC) has been well described historically as a pedicled mandibular reconstructive alternative.…”