Microvascular transfer of burned tissue for mandibular reconstruction

We present a case of mandibular reconstruction using a free-vascularized fibula osteocutaneous flap after invasive infection of the mandible with mucormycosis. Unique to this case is the skin paddle that previously sustained full-thickness burn injury treated with cultured skin substitute (CSS). A 10-year-old boy sustained a 96% total body surface area burn. CSS was used to obtain wound closure. However, he developed invasive mucormycosis of the mandible requiring resection. The best option for mandibular reconstruction was the use of a free-vascularized fibular osteocutaneous flap with CSS as a skin paddle. The reconstruction was performed without complications. To our knowledge this is the first case describing the use of CSS in free tissue transfer. With the improved prognosis in massively burned patients and the increased use of cultured skin for wound coverage, complex reconstruction using previously burned tissue will be required. Previously burned skin including tissue grafted with skin substitutes attains vascularity and healing properties that allow flap elevation for burn reconstruction. Successful utilization of previously burned skin relies on the ability to provide adequate blood supply to the flap by preservation or regeneration of its angiosome.