title: Double Free Flap Transfer using a Vascularized Free Fibular Flap and a Rectus Abdominalis Musculocutaneous Flap for an Extensive Oromandibular Defect: Prevention of Sinking or Drooping of the Flap With an Anterior Rectus Sheath.
abstract: The double free flap procedure is a preferred treatment for extensive composite defects of the oromandibular area. In this procedure, the choice and use of the flaps are both important. Flaps with adequate soft tissue are required to fill the extensive dead space for huge oromandibular defects. Such flaps, however, tend to sink and droop with time because of gravity, resulting in poor functional and aesthetic results. Here, the authors describe a procedure that avoids flap sinking and drooping, using a vascularized fibular osteocutaneous flap, which is well established for mandibular bone defects, and a rectus abdominalis musculocutaneous flap, which has a lot of soft tissue and a firm anterior rectus sheath. This method was used in 2 patients with extensive composite defects of the oromandibular area. In a patient with resection of the mobile tongue and oral floor, the anterior rectus sheath was fixed to the fibula and mandible to give a mylohyoid muscle-like structure, to prevent sinking of the reconstructed oral floor and tongue. Good swallowing function was maintained. In a patient with defects transversally from the submandibular region to the cheek, the sheath was fixed to the zygomatic arch to prevent cheek drooping. An acceptable aesthetic result was obtained.
authors.affiliation: *Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Kobe †Department of Plastic Surgery, Kobe University Graduate School of Medicine, Gunma, Japan.
authors.forename: Takaya
authors.initials: T
authors.lastname: Makiguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoo
authors.forename: Yu
authors.initials: Y
authors.lastname: Takayama
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Miyazaki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Terashi
mesh_terms: D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002610:Cheek / Q000601:surgery; D003679:Deglutition / Q000502:physiology; D004954:Esthetics; D005360:Fibula / Q000601:surgery; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009060:Mouth Floor / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery*; D064827:Myocutaneous Flap / Q000637:transplantation*; D009808:Odontogenic Tumors / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000601:surgery; D014062:Tongue Neoplasms / Q000601:surgery; D060053:Transplant Donor Site / Q000601:surgery; D016896:Treatment Outcome