Pedicled Latissimus Dorsi/Rib Myo-osseocutaneous Flap Reconstruction for the Mandibular Defect in a Patient with Consecutive Failures of Two Free Fibular Flaps-Case Report and Review of the Literature

Background:Microvascular free tissue transfer has become the choice of reconstruction for complex head and neck defects. For large mandibular defect, free fibular flap is the mainstream flap for the mandibular reconstruction. Despite the advances in microsurgery and the experience gained in clinical practice, management of consecutive two free fibular flaps failures remains challenging to reconstructive microsurgeons.Aim and Objectives:We report a case with large mandible and soft tissue defect after consecutive failures of two free fibular flaps. We successfully reconstructed the defect with pedicled latissimus dorsi/rib myo-osseocutaneous flap.Materials and Methods:A 57 year-old male with a history of hypertension, diabetes mellitus, and recurrent stage II squamous cell carcinoma of lower left gum and mouth was transferred to our hospital with a huge orocutaneos fistula and neck infection. He received surgical resection of left lower gum cancer and segmental mandibuletomy in another hospital. However, the reconstructive procedures were complicated with consecutive failures of left and right fibular flaps. Both flaps were totally lost, and were removed at other hospital. After being transferred to our hospital, we arranged adequate debridement, and the defect was reconstructed with pedicled latissimus dorsi/rib myo-osseocutaneous flap.Results:The bone and soft tissue defect were successfully reconstructed with pedicled latissimus dorsi/rib myo-osseocutaneous flap. The patient regained oral intake in three weeks.Conclusion:Pedicled latissimus dorsi/rib myo-osseocutaneous flap may serve as a good reconstructive alternative for patients with large bone and soft tissue defect after consecutive failures of free fibular flap. This flap may cover the orocutaneous fistula, reconstruct the bony defect, rebuilt the oral function, and prevent further neck infection in one stage.