Reconstruction of lower third of face with three simultaneous free flaps

A case of massive osteoradionecrosis is presented that required angle-to-angle resection of the mandible and replacement of skin of the chin and neck as well as the entire floor of the mouth. In this heavily irradiated patient, three microvascular free flaps were transferred in one operation. A large radial forearm flap was used to reconstruct the floor of the mouth. A second large radial forearm flap was used to reconstruct the chin and neck defects and a fibular osseous flap was used to reconstruct the mandible. All wounds healed primarily. For extremely complicated and large defects, the transfer of multiple free flaps may provide the best reconstruction.