Double free flap reconstruction of through-and-through oromandibulofacial defects

Abstract

Through-and-through oromandibulofacial resection defects are extensive reconstructive challenges. These composite defects consist of five components that have to be addressed separately in order for the reconstruction to be functionally and aesthetically successful, including the oral mucosa, bone defect, external skin, potential deadspace obliteration and volume replacement. Single osteocutaneous flaps or single soft tissue free flaps inevitably lead to compromise in at least one of these areas. More recently, in the last two decades, double free flaps have been introduced as a tailored solution to this problem, allowing the comprehensive reconstruction of each separate component. We review the current evidence regarding the use of double free flaps in such defects and summarise our approach in our institute’s experience of over 130 cases. Although we consider the double free flap combination of the anterolateral thigh (ALT) flap and fibula osteoseptocutaneous flap to be the optimal reconstructive method in through-and-through oromandibulofacial defects, higher levels of evidence are required to fully justify their use in terms of complication profile, functional and aesthetic outcomes.