PMC6161216_01
Composite oral cavity defect. Through-and-through defect following composite mandibular resection and resection of the entire chin pad.
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F1
The patient was a 65-year-old man with recurrent oral cavity squamous cell carcinoma who underwent a composite resection of the floor of mouth, the mandible from angle to angle, and the entire chin pad (Fig 1).
Simultaneous harvest of anterior tibial perforator free flap and fibular osteocutaneous free flap. Anterior tibial perforator supplying the anterior border of skin paddle.
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F2
Once an anterior incision was made, an anterior-lateral perforator supplying the skin paddle was encountered (Fig 2).
Fibular free flap plated into a reconstruction plate, shown with attached anterior tibial perforator flap (ie, flow-through free flap). Anterior tibial perforator sewn to the distal end of the peroneal artery, microvascular anastomosis for flow-through free flap performed in the leg (short arrow). Vasculature of fibula anastomosed to the right facial artery, the external jugular vein, and a large common facial vein (long arrow).
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F3
The pedicle to the anterior tibial perforator was then sewn to the distal ends of the peroneal artery and of one of the venae comitantes (ie, flow-through technique) (Fig 3).
Inset of fibular flow-through free flap. Reconstruction of composite defect. Blue stitch located at the site of anterior tibial perforator.
eplasty18e24_fig4.jpg
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F4
The peroneal perforator was centered in the skin paddle for the floor of mouth reconstruction, and the tibial perforator was centered in the skin paddle of the chin (Fig 4).