[The need for successive free flap applications for soft-tissue reconstruction in a case with recurrent oral...

A case of difficult oncologic oral reconstruction is illustrated, in which soft tissue deficits resulting from failure of conventional techniques were treated by successive free tissue transfers. A thirty-eight-year-old man presented with squamous cell carcinoma in the right retrotrigonal region. The tumor was resected and the defect was reconstructed with the use of a tongue flap and skin graft. However, trismus occurred following radiotherapy, which was released by the help of a radial forearm free flap. The patient developed local recurrence several months later and right hemimandibulectomy, total maxillectomy, and hemiglossectomy were performed. The resulting en bloc defect was reconstructed by a free fibula osteocutaneous flap combined with a pedicled extended pectoralis major myocutaneous flap. The pectoralis flap was complicated by partial necrosis resulting in a large orocutaneous fistula and oral commissure incompetence. As the source of either a local or regional flap was inadequate, an anterolateral thigh myocutaneous free flap was used to fill the maxillary defect. No complications were encountered associated with free tissue transfers and the patient was able to take a soft diet three weeks after the final procedure.