[Mandibular reconstruction using a pedicled osteomyocutaneous flap of the latissimus dorsi]

The authors report their experience with reconstruction of loss of mandibular substance due to wide or complicated resections for cancer. A series of 8 reconstructions using a latissimus dorsi osteo-myocutaneous pediculated flap and the 10th rib helped to define the advantages and disadvantages of this form of complex flap. Since a latissimus dorsi pediculated flap has classically been used in maxillo-facial reconstruction, an osteo-myocutaneous flap, including a portion of the 10th rib, is naturally appropriate for the reconstruction of a major loss of substance involving the mandible and related structures. The separation technique and trans-cervical transposition are described. The advantages of this form of flap are the ease with which it may be detached and the reliability of the vascular pedicle. The principal disadvantages are the relatively large volume, the difficulty in dissociating the cutaneous layer from the bony layer and the difficulties involved in the fixation of the bone graft to a prosthetic plate. Problems with rehabilitation are also discussed.