Reconstruction of Through-and-Through Composite Segmental Mandibulectomy Defect in a Patient with a Dominant Peroneal Artery Using an Anterior Lateral Thigh Osteomyocutaneous (ALTO) Free Flap: A Case Report and Description of Flap

Abstract Anterior lateral thigh osteomyocutaneous (ALTO) free flap represents a unique reconstructive option for patients who are otherwise not a good candidate for traditional free flaps for a through-and-through defect of the head and neck. Here we present a case of a patient with squamous cell carcinoma of the oral cavity who underwent composite segmental mandibulectomy with a resultant through-and-through defect. The patient was not a candidate for fibula free flap reconstruction due to the presence of bilaterally dominant peroneal arteries. The patient underwent reconstruction with a single free tissue ALTO flap with good viable flap post operatively. The patient did not experience any major or minor surgical complications and is living with no evidence of disease. The ALTO free flap may be an effective flap in the reconstruction of through-and-through defects of the mandible in patients that are not candidates for a fibula free flap based reconstruction.