Purpose Reconstruction of composite anterior mandibular defect (CAMD) requires the challenging restoration of oral competence and function. This study aimed to evaluate two novel modifications of the Osteomyocutaneous Peroneal Artery-based Combined (OPAC) flap for CAMD with or without lip preservation. Methods CAMDs reconstructed using either of the modifications in a one-year period from February 2020 were studied. When the entire lower lip-chin unit was resected (lip-resected group) a chimeric, bipaddled OPAC flap was used with a Palmaris Longus sling. The larger, inner skin paddle reconstructed the floor of the mouth, alveolus and lower lip draping itself over the sling, while the chimeric paddle was used for the chin defect. Whenever a viable band of lip mucosa was preserved (lip-preserved group), a single large skin paddle covered the chin defect while the intact Crural septum recreated the oral lining with the residual lip intervening. Patients were prospectively evaluated for oral function, symmetry, flap complications and donor site morbidity at one and six months. Results 19 patients were included (8 lip-preserved;11 lip-resected). Mouth opening (mean-35.1 mm), subjective oral competence and facial symmetry were satisfactory at 6 months. Objective measures of speech, eating and aesthetics significantly improved at 6 months (p<0.01, compared to pre-operative). Complications (graft loss-3, wound dehiscence-2) were managed conservatively. Conclusion These modifications of the OPAC flap for CAMDs have the advantage of a single donor site, satisfactory oral competence, function and facial symmetry. Flap complication and donor-site morbidity are minimal. This is a prudent replacement to the current practice of double-free flaps in the reconstruction algorithm of CAMDs. Reconstruction of composite anterior mandibular defect (CAMD) requires the challenging restoration of oral competence and function. This study aimed to evaluate two novel modifications of the Osteomyocutaneous Peroneal Artery-based Combined (OPAC) flap for CAMD with or without lip preservation. CAMDs reconstructed using either of the modifications in a one-year period from February 2020 were studied. When the entire lower lip-chin unit was resected (lip-resected group) a chimeric, bipaddled OPAC flap was used with a Palmaris Longus sling. The larger, inner skin paddle reconstructed the floor of the mouth, alveolus and lower lip draping itself over the sling, while the chimeric paddle was used for the chin defect. Whenever a viable band of lip mucosa was preserved (lip-preserved group), a single large skin paddle covered the chin defect while the intact Crural septum recreated the oral lining with the residual lip intervening. Patients were prospectively evaluated for oral function, symmetry, flap complications and donor site morbidity at one and six months. 19 patients were included (8 lip-preserved;11 lip-resected). Mouth opening (mean-35.1 mm), subjective oral competence and facial symmetry were satisfactory at 6 months. Objective measures of speech, eating and aesthetics significantly improved at 6 months (p<0.01, compared to pre-operative). Complications (graft loss-3, wound dehiscence-2) were managed conservatively. These modifications of the OPAC flap for CAMDs have the advantage of a single donor site, satisfactory oral competence, function and facial symmetry. Flap complication and donor-site morbidity are minimal. This is a prudent replacement to the current practice of double-free flaps in the reconstruction algorithm of CAMDs.
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