Osteocutaneous clavicular free flap: A modified approach for compound defects reconstruction

A 67-year-old male patient with persistent adenoid cystic carcinoma in the floor of the mouth underwent a glosso-mandibulectomy and left cervical lymph node dissection. After the defect was identified, the reconstructive team chose a modified osteocutaneous clavicular technique using a local internal mammary artery perforator for reconstruction due to the patient's preference to avoid lower extremity involvement. The flap was harvested and positioned over the defect, with the bone fixed using a 2.4 mm system reconstruction plate. In the postoperative period, the flap exhibited mild venous congestion during the initial 12-h period, but without any skin morbidity. The patient has not reported any functional or sensory complaints. This case report presents a modified alternative approach for CD reconstruction in the face, using a clavicular osteocutaneous free flap to reconstruct a mandibular defect and mouth floor. This case report demonstrates the importance of considering patient preferences and individual needs when selecting a free flap option for reconstructive surgery and highlights the potential of modified techniques using alternative free flaps to achieve successful outcomes.