Closure of total cheek defects with two combined myocutaneous free flaps

Closure of a large, full-thickness defect after radical ablation of advanced cancers in the oropharyngeal region has often presented problems. We designed the one-stage, microsurgical free transfer of two musculocutaneous flaps-the latissimus dorsi flap and the serratus anterior flap-with one common nutrient pedicle formed by the thoracodorsal vessels. The serratus anterior flap was turned into the buccal mucosal defect, while the latissimus dorsi flap was placed in the cheek cutaneous defect. The flaps were then revascularized by anastomosing the nutrient thoracodorsal vessels to the selected recipient vessels. This particular procedure was successfully achieved in two clinical cases with large, full-thickness defects in the cheek. Functional disabilities after removal of two muscles were unexpectedly minimal in both cases.