The Super Thin External Pudendal Artery Free Flap for Buccal Reconstruction: A Case Report

Reconstruction of buccal mucosal defects requires thin, pliable, and well-vascularized tissue to preserve oral function and cheek mobility. While the radial forearm free flap remains widely used, alternative ultra-thin options are needed, particularly in obese patients where conventional perforator flaps may be excessively thick. We report the case of a 59-year-old obese man (BMI 32 kg/m²) undergoing resection of a superficial squamous cell carcinoma of the left buccal mucosa, resulting in a wide 6 × 6 cm defect. Reconstruction was performed using a super-thin external pudendal artery (STEPA) free flap harvested from the hemiscrotum. The fasciocutaneous flap, measuring 6 × 6 cm, demonstrated uniform near-millimetric thickness (2-3 mm), allowing direct intraoral inset without the need for thinning. Microvascular anastomoses were performed to the facial vessels, and donor-site closure was achieved primarily. The postoperative course was uneventful, with early enteral feeding, progressive oral intake from day 10, and no complications. At 3 months of follow-up, the flap showed complete integration with preserved cheek mobility and satisfactory mouth opening. This case highlights that the STEPA free flap may represent a useful ultra-thin reconstructive option for buccal mucosal defects in selected patients, particularly when minimal flap thickness is required.