Free combined anterolateral thigh flap and vascularized fibula for wide, through-and-through oromandibular defects

Through-and-through oromandibular defects require the greatest amount of soft-tissue volume among the transfers for head and neck defects. A new method, a large anterolateral thigh flap combined with a vascularized fibula graft in a chimera fashion, has been used for two patients with wide through-and-through oromandibular defects. Among the candidates for such a large skin flap, the anterolateral thigh flap seems to be the best, for the following reasons. (1) Its pedicle, the lateral circumflex femoral system, has several major branches of equal size of anastomosis of the peroneal vessels. (2) As the majority of such patients with multiple previous surgery have lost recipient vessels near the mandible, the longest vascular pedicle is required. (3) There is no need for positional changes, and simultaneous flap elevation with the tumor resectioning is possible. (4) Use of the fibula allows for reconstruction of the entire mandible, if necessary. (5) Some of the shortcomings of individual donor sites for massive composite osteocutaneous flaps are minimized, because each component consists of two donor sites. (6) Operating time for this flap elevation is minimized, compared to that for massive composite osteocutaneous flaps, because the individual components can be obtained simultaneously by two teams.