Simultaneous Reconstruction of Large Maxillary and Mandibular Defects with a Fibular Osteocutaneous Flap Combined with an Anterolateral Thigh Flap

Abstract

This article reports the simultaneous reconstruction of maxillary and mandibular defects caused by a close-range gunshot blast to the face with one fibular osteocutaneous flap combined with an anteroateral fasciocutaneous flap. A fibular osteocutaneous flap was used for both mandibular and maxillary defects, using multiple osteotomies and discarding a central bony segment and an oral floor defect. An anterolateral thigh flap was used to cover a three-dimensional defect of both the intraoral mucosal region, as well as external skin and soft tissue defects, including some on the upper and lower lips. The results demonstrated that the method was a good choice in the reconstruction of large composite facial defects, both aesthetically and functionally.

Repair of buccal defects with anterolateral thigh flaps

“…Despite its common use for soft-tissue defects in clinical series, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] no specific reports have focused on presenting the reliability of the anterolateral thigh flap in buccal defects. This flap has a number of advantages, including a long vascular pedicle with a suitable diameter for microsurgical anastomosis, and a large cutaneous area with acceptable donor-site morbidity.…”

“…[26][27][28] Although the perforator vessel of the flap is musculocutaneous in most cases [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] (in 60-90% of cases, depending on the series), it can also be isolated as septocutaneous. Flap elevation is slightly more difficult when the pedicle is musculocutaneous.…”

“…As reported in many studies, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] variations in the vascular pedicle have no considerable effect on the success rate of the flap. With increased experience with the flap and anatomical variations of the pedicle, elevation can be carried out more easily and operation time can be reduced dramatically, especially compared with the most commonly used conventional free flaps.…”

“…[6][7][8] Since the first report of the anterolateral thigh flap by Song et al in 1984, 9 because of its large cutaneous area and long vascular pedicle with a suitable vessel diameter with acceptable donorsite morbidity, and because it offers a number of evident advantages, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Here, we review our experiences with free anterolateral thigh flaps on buccal defects in a series of 24 patients. The functional and structural advantages of the anterolateral thigh flap, including its versatility and usefulness, are presented and discussed.…”

Microvascular Complications in Head and Neck Defects Reconstructed with Free Flaps

“…Serbest flepler, baş ve boyun tümörlerinde cerrahi eksizyon sonrası oluşan defektlerin kapatılmasında sıklıkla kullanıldığı gibi; trafik kazaları, ateşli silah yaralanmaları sonrası oluşan defektlerin kapatılmasında da kullanılır (3,4). Hemifasial mikrosomi gibi durumlarda yüzü yeniden şekillendirmede ve yanık rekonstrüksiyonunda da serbest flep seçenekleri sıklıkla kullanılmaktadır(5, 6).…”