Reconstruction of Complex Orofacial Defects: A Preliminary Experience with Composite Tissue Flaps Based on the...

This study presents a systematic summary of composite tissue flap reconstruction strategies centered on the versatile anterolateral thigh (ALT) flap for complex orofacial defects. Through a retrospective analysis of 21 patients (mean age 56.4 years) at a single center, it details the rationale, surgical protocol, and outcomes of four synergistic flap combinations. These include: 1) ALT with pectoralis major myocutaneous flap for large oropharyngeal-cervical through-and-through defects; 2) ALT with fibular osteomyocutaneous flap for composite mandibular and soft tissue defects; 3) ALT with free auricular composite flap for combined large soft tissue and specialized subunit (e.g., alar rim) defects; and 4) double ALT flaps for extensive, three-dimensionally complex soft tissue defects. The procedural framework elaborates on precise indication selection, anatomical design based on perforator mapping, meticulous sequential flap harvest via standardized approaches, and key technical aspects of microvascular anastomosis. Representative results from the cohort demonstrated a 100% flap survival rate. Postoperative complications were manageable (9.5%), including one orocutaneous fistula and one donor-site seroma, neither compromising final outcomes. The findings establish a practical, individualized clinical framework that integrates reliable surgical techniques with functional-aesthetic goals, offering a practical and adaptable approach for the precise reconstruction of severe, multifaceted orofacial defects.