Double free flap reconstruction for anterior segmental mandibulectomy an enegma- a case report

Abstract

BACKGROUND: Mandible reconstruction is one of the major challenges that any maxillofacial surgeon faces world wide. Different approaches and methods are used for mandible reconstruction.The use of a re-vascularised free fibula flap as bone graft has become a corner stone in the head neck armamentarium. When the defects are too large single flaps may not be sufficient and may not be able to provide sufficient soft tissue coverage and a second free flap may be necessary.
Case presentation–Here we present a case of well differentiated squamous cell carcinoma of the lower anterior alveolus. The patient was planned for a middle third mandibulectomy with modified radical neck dissection and tracheostomy and for the reconstruction a free fibula flap was planned, but due to intra operative complications and second anterolateral thigh flap had to be harvested and grafted.
Discussion-The use of double free flaps is a standard practice following resection of advanced oral cancers particularly those involving large defects of both bone and soft tissue. In this case the indication for a double free flap was requirement for and soft tissue/skin not provided by the skin island of the free fibula flap.
CONCLUSION-Being aware of the anatomical variations is an important factor while harvesting a flap safely with minimal donor site morbidity.By using two free flaps, the best osseous and soft tissue elements may be independently selected yielding appropriate tissue characteristics for ideal defect reconstructions.