Use of a rectus abdominis osteomyocutaneous double island flap based on internal mammary vessels

A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible because of two previously-failed free flaps and an operative field that was densely fibrotic. A pedicled rectus abdominis myocutaneous flap with incorporated vascularized rib graft is described as a last resort approach for simultaneous reconstruction of the mandible and oral soft tissue.