title: Reconstruction of Through-and-Through Oromandibular Defects With Combined Fibula Flap and Anterolateral Thigh Flap.
abstract: OBJECTIVE
  The reconstruction of massive through-and-through oromandibular defects is still a challenge because no single adequate candidate for a donor site of vascularized bone and a large amount of soft tissue has yet been found. The aim of this study was to evaluate the feasibility and reconstructive efficacy of the combined fibula flap and anterolateral thigh (ALT) flap in tandem for the reconstruction of such defects.
  
  
  METHODS
  We performed a retrospective case series of patients who had undergone reconstruction of through-and-through oromandibular defects with the combined fibula flap and ALT flap in tandem from January 2012 through December 2014 at the Second Xiangya Hospital. The flap design and the methods for defect reconstruction are described, and the reconstructive efficacy is reported.
  
  
  RESULTS
  Of the 14 patients, 13 were men and 1 was a woman, with an average age of 49.36 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. All of the donor sites were closed directly, leaving only linear scars and no thigh or leg motor dysfunction. All patients were followed for approximately 12 to 48 months, and the appearance and oral functions were acceptably recovered in about 90% of the patients.
  
  
  CONCLUSIONS
  Because of the convenient flap design, satisfactory functional and esthetic results, and lower complication rates at the donor and recipient sites, the use of a combined fibula flap and ALT flap in tandem is a good choice for the reconstruction of complex through-and-through oromandibular defects.
authors.affiliation: Visiting Physician, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Zhao-Jian
authors.initials: ZJ
authors.lastname: Gong
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China, and Department of Clinical Medicine, Fujian Medical University, Fuzhou, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Liu
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Xu
authors.affiliation: Professor and Department Head, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital, Central South University, Changsha, China. Electronic address: wuhanjiang0198@sina.com.
authors.forename: Han-Jiang
authors.initials: HJ
authors.lastname: Wu
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D013848:Thigh / Q000601:surgery*; D016896:Treatment Outcome