Reconstruction for Complex Oromandibular Facial Defects: The Fibula Free Flap and Pectoralis Major Flap Combination

Table 1

Summary of patient description, tumor characteristics, treatment rendered, and outcomes.

	Age	Pathology	Stage	Months of follow up	Site involved-resultant defect	Reconstruction	# of fibular segments	Size of fibula skin paddle	Size of pectoralis major myocutaneous paddle	Functional outcome	Complications
Patient 1	20 year old African American Male	High Grade Osteosarcoma	T2N0M0G3	29 months	10 × 9 cm lesion right mandible extending form right subcondylar area to left premolar region, involved floor og mouth, buccal mucosa and right cheek and neck skin	Free fibular flap with skin paddle intraorally and pectoral major myocutaneous skin paddle for external defect	3	7 × 12 cm	11 × 9 cm	Excellent. Good oral intake. Mouth opening 40 mm	Hardware exposure at 14 months. Treated with hardware removal.
Patient 2	65 year old male	Squamous cell carcinoma	T4aN0	19 months	Right buccal mucosa lesion extending to maxillary gingiva and mandible, with full thickness involvement of the right half of lower lip and cheek/chin area	Free fibular flap with skin paddle intraorally and pectoral major myocutaneous skin paddle for external defect	1	7 × 9 cm	6 × 5 cm	Good oral intake. Microstomia due to lip resection and post operative adjuvant therapy	Delayed wound healing at distal end of pectoralis major myocutaneous skin paddle. Managed succesfully with wound care. At 16 months underwent commissurotomy to try to improve microstomia, however developed wound breakdown. Moved to another city at 19 months
Patient 3	53 year old American male	Squamous cell carcinoma	T4aN2c	17 months	Left mandible extending from right premolar region, included floor of mouth, buccal mucosa, lower lip, chin and neck skin	Free fibular with skin paddle intraorally and pectoral major myocutaneous skin paddle for external defect	2	9 × 4 cm	10 × 8 cm	Percutaneous tube dependent, with some oral intake. Microstomia due to lip resection and adjuvant therapy	Delayed healing at distal end of pectoralismajor myocutaneous skin paddle. Managed successfully with wound care. Following chemo and radiation developed partial exposure of the left posterior fibular segment. Patient elected to observe area.