Extensive Tissue Defects Research Articles

Managing malignant sublingual gland tumors: a single institution experience with 23 patients

BackgroundDue to the relative rarity of malignant sublingual gland tumors, diagnosing and treating them clinically pose challenges. Hence, there’s a need to explore the pathological types, characteristics, treatment methods, and prognosis of primary malignant tumors of the sublingual gland to improve our understanding and management of these rare yet highly malignant conditions.MethodsThis study reviewed cases of primary malignant sublingual gland tumors, analyzing their characteristics. The treatment methods included surgical excision, with additional radiotherapy, or brachytherapy for advanced stages or positive surgical margins. The study also summarized different treatment approaches, including lymph node dissection and soft tissue reconstruction using free flaps such as the anterolateral thigh flap and forearm flap.ResultsWe have gathered 23 cases of sublingual gland malignancies treated at the Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, from January 2013 to May 2024. The most common pathological types were adenoid cystic carcinoma and mucoepidermoid carcinoma, with rare cases of mucosa-associated lymphoid tissue (MALT) lymphoma and nonspecific salivary gland clear cell carcinoma. Early diagnosis and surgical intervention were crucial for a favorable prognosis. Marginal mandibulectomy was necessary for cases involving the mandible. Patients with positive preoperative lymph node detection required cervical lymph node dissection. Extensive tissue defects in the floor of the mouth were effectively reconstructed with free flaps to prevent oral-mandibular fistula.ConclusionSurgical excision remains the preferred treatment for malignant sublingual gland tumors. Early diagnosis and comprehensive surgical management are essential for improving prognosis. The study’s limitations include a small sample size and short follow-up duration, necessitating further research with larger clinical samples to confirm these findings.

Reconstruction With Flow-Through Chimeric Anterolateral Thigh Flap Combining Vascularized Fibular Bone Graft for Extensive Composite Tissue Defect of the Forearm: A Case Report.

The management of critical limb trauma is challenging because limb salvage is preferable to amputation. For upper limb reconstruction, the surgical restoration of functionality, and appearance, a multidisciplinary approach is needed. We report the case of an extensive composite tissue defect of the forearm caused by a machine-crushing injury that was repaired by a flow-through chimeric anterolateral thigh flap with a vascularized fibular graft. Reconstruction was performed as a single-stage procedure; no complications occurred, and both functional and aesthetic outcomes were satisfactory.

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series.

Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7cm2, 96mm, and 68.9cm2. The mean surgical procedures took 712.5min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.

Reconstructive surgery and adjuvant radiotherapy for the multimodal approach in oral cancer: a single cancer centre experience

Introduction and importance: Ablative surgery for oral cancer, irrespective of the histological subtype, causes large tissue defects, functional and aesthetic damage. Microsurgical free flaps have been widely used in reconstruction after resection, with satisfactory success rates in conjunction with adjuvant radiotherapy (RT). This study aims to describe our clinical institutional experience based on the multimodal treatment performed in four cases diagnosed with oral squamous cell carcinoma with the use of different microvascular free flaps and RT. Case series presentation: Four patients underwent reconstructive microsurgery after surgical resection of oral cancer, using three types of free flap: radial forearm fasciocutaneous, osteomyocutaneous fibular, and anterolateral thigh musculocutaneous flaps; RT was performed in Case 2 and Case 3. In the period of 3 years after microsurgical reconstruction and RT, flaps remain clinically stable without failure signs in full patients submitted to multimodal treatment. Clinical discussion: After resection of oral carcinomas, extensive tissue defects can be successfully treated with reconstructive microsurgery using different types of microvascular free flaps. RT for locoregional control is a feasible option and did not seem to interfere with the survival of flaps. Conclusion: An enhance long-term follow-up to assess overall and disease-free survival rates and quality of life must be carried out; however, cohort studies would be necessary for better understanding of the role of each treatment in the multimodal scheme.

Laparoscopic harvest and free transplantation of great omentum flap for extensive tissue defects in complex wounds

IntroductionThe repair of extensive tissue defects remains a challenge, although great progress has been made in reconstructive surgery. The transplantation of a single huge flap or several flaps in combination will inevitably result in donor-site morbidity. Here we report our experience in the repair of these wounds with laparoscopically harvested great omentum flaps. MethodsTwelve patients with extensive tissue defects caused by deep burn injury, avulsion injury, and open fracture underwent free omental flap transplantation and split-thickness skin grafting. The patient demographics, wound characteristics, and complications postsurgical operation were recorded. Prior to omentum flap transplantation, these patients underwent debridement, vacuum sealing drainage treatment, and/or fixation of fractures. All omentum flaps harvested using laparoscopic technique were anastomosed to recipient vessels, and split-thickness skin grafting was performed 14 days after omental flap transplantation. ResultsThe mean defect size was 471 cm2 and the mean omental flap size was 751.1 cm2. Among all 12 cases, the omental flaps survived well except for distal partial necrosis in one case. Skin grafting was also achieved in all cases, and all patients achieved complete wound coverage. All donor sites achieved primary healing without major complications. The mean follow-up time was 30 months with satisfactory appearance and functional outcome. ConclusionFor the reconstruction of extensive tissue defects in complex wounds, the free transfer of an omental flap may be an ideal option because of its well-vascularized and pliable tissue with reliable vascular anatomy, as well as minimized donor-site morbidity.

Anterolateral Thigh Chimeric Flap: An Alternative Reconstructive Option to Free Flaps for Large Soft Tissue Defects.

The anterolateral thigh (ALT) skin flap provides abundant, thin, pliable skin coverage with adequate pedicle length and calibre, and tolerable donor site morbidity. However, coverage of relatively large defects using the ALT flap alone is limited. We present our experience of using the ALT flap coupled with the vastus lateralis (VL) flap supplied by the same pedicle for large defect reconstruction. Between 2016 and 2020, ten patients with extensive lower-extremity or trunk defects were treated using the ALT/VL chimeric flap. The ALT portion was used to cover the cutaneous and joint defect while the VL part was used to resurface remnant defects, and a skin graft was performed. All flaps were based on the common descending pedicle, and branches to separate the components were individually dissected. All defects were successfully reconstructed using the ALT/VL chimeric flap. No surgery-related acute complications were observed, and the patients had no clinical issues with ambulation or running activities during the long-term follow-up period. With the separate components supplied by a common vascular pedicle, the ALT/VL chimeric flap allows us to reconstruct extensive defects with joint involvement or posterior trunk lesions. Thus, the ALT/VL chimeric flap may be a suitable alternative for extensive tissue defect reconstruction.

Noma: difficulties of diagnosis (clinical case)

The paper describes two clinical cases of treatment of patients with noma. This disease is extremely rare in the Russian Federation, and therefore its diagnosis causes difficulties, and incorrect routing of patients, due to diagnostic mistakes, leads to an increase in the time before the start of specialized care. Rapid progression of wet gangrene, in the absence of timely diagnosis and qualified treatment, leads to extensive defects of the maxillofacial region, severe intoxication, sepsis. In the first case, after surgical treatment of noma, the patient developed an extensive tissue defect of the left half of the face, which in the future will require reconstructive surgical treatment. In the second case, after surgical treatment, the patient had an extensive tissue defect in the middle zone of the face, and systemic disorders against the background of intoxication led to the death of the patient on the 7th day after hospitalization. Both clinical cases confirm the role of immunosuppression in the etiology of noma.

Maxillo-mandibular Defect Reconstruction with Bilateral Free Fibula Flaps with Dental Implant Placement and Immediate Loading: A Case Report of the Three-team Approach.

Patients with advanced malignant tumors, including both jaws, is a challenging task for a head and neck surgeon. Current treatment landscape demonstrates good functional, anatomical, and aesthetic results in patients who could previously receive only palliative care. The extensive tissue defects resulting from oncological resections in the head and neck region require immediate reconstruction due to the exposure of vital structures and their contact with the external environment. A patient was operated using a three-team multidisciplinary approach involving simultaneous work of three specialized teams of maxillofacial and reconstructive microsurgeons, as well as an implantologist and a prosthodontist. This approach allowed simultaneous tumor resection with subsequent reconstruction of the intraoperative defect involving bilateral harvesting of two revascularized free fibular osteomusculocutaneous flaps with dental implantation and simultaneous rehabilitation of dentition with crowns.

A Multidisciplinary Approach to Complex Dermal Sarcomas Ensures an Optimal Clinical Outcome.

Simple SummaryKnowledge of cutaneous or dermal sarcomas is crucial due to the initially peaceful appearance of skin tumours, causing delays in accurate diagnoses. They can easily be mistaken for benign skin appendages or moles. This clinical entity spans from low-grade tumours with practically no metastatic potential to highly aggressive neoplasms with substantial morbidity. Initial adequate resection is the absolute mainstay of successful therapy. Extensive tissue defects after resection necessitate a multidisciplinary approach involving reconstructive surgical planning from onset. Clinical and morphological types of dermal sarcomas are presented together with examples of cases undergoing interdisciplinary treatment and advanced microsurgical reconstructive therapy. Clinicians should be aware of the types of dermal sarcomas; their specific clinical presentations and growth patterns; as well as the necessity of clear surgical margins and the significant progress in reconstructive surgery, which gives new hope for future management of complex dermal sarcomas.Primary dermal sarcomas (PDS) belong to a highly clinically, genetically and pathologically heterogeneous group of rare malignant mesenchymal tumours primarily involving the dermis or the subcutaneous tissue. The tumours are classified according to the mesenchymal tissue from which they originate: dermal connective tissue, smooth muscle or vessels. Clinically, PDS may mimic benign soft tissue lesions such as dermatofibromas, hypertrophic scarring, etc. This may cause substantial diagnostic delay. As a group, PDS most commonly comprises the following clinicopathological forms of dermal sarcomas: dermatofibrosarcoma protuberans (DFSP), atypical fibroxanthoma (AFX), dermal undifferentiated pleomorphic sarcoma (DUPS), leiomyosarcoma (LMS), and vascular sarcomas (Kaposi’s sarcoma, primary angiosarcoma, and radiation-induced angiosarcoma). This clinical entity has a broad spectrum regarding malignant potential; however, local aggressive behaviour in some forms causes surgical challenges. Preoperative, individualised surgical planning with complete free margins is pivotal along with a multidisciplinary approach and collaboration across highly specialised surgical and medical specialties. The present review gives a structured overview of the most common forms of dermal sarcomas including surgical recommendations and examples for advanced reconstructions as well as the current adjunctive medical treatment strategies. Optimal aesthetic and functional outcomes with low recurrence rates can be achieved by using a multidisciplinary approach to complex dermal sarcomas. In cases of extended local tumour invasion in dermal sarcomas, advanced reconstructive techniques can be applied, and the interdisciplinary microsurgeon should be an integral part of the sarcoma board.

Perforator-based keystone flap in the reconstruction of extensive tissue defects after lumbosacral spondylodesis

Prolonged surgical site infections after spinal fusion surgery may lead to exposure of the implant due to the formation of extensive tissue defects and endanger the clinical outcome. This study aims to enlighten the role of the keystone perforator flap method in the reconstruction of lumbar soft tissue defects. The retrospective study included 11consecutive patients with a wound dehiscence of over 6 × 6 cm defect area persisting for 2weeks after spinal fusion. The keystone perforator flap was applied for the reconstruction of tissue defects, whereas the arterial blood supply of the flaps was based on the intramuscular and intermuscular perforating branches of the dorsal branches of the lumbar arteries. The median age of our cohort was 58years. The median body mass index (BMI) and Charlson comorbidity index (CCI) were 29.9 and 3.4, respectively. In eight cases alumbosacral was carried out whereas in the remaining series alumbar fusion was performed. In the course of the subsequent wound revision, on average 4applications of negative pressure wound therapy (NPWT) were performed. The average defect size was 7.5 cm in width and 16.5 cm in length. The microbiological analysis of the tissue samples obtained intraoperatively after repeated NPWT revealed positive evidence of pathogenic bacteria in all cases. The average duration of inpatient treatment after flap surgery was 15days, which was significantly shorter than the NPWT management of the open defect wounds (15.5 ± 2.5 vs. 37 ± 16.5, p < 0.05). The keystone perforator flap offers astable coverage for soft tissue defects and supports infection control after spinal fusion.

Surgical treatment of children with extensive bone defects (Literature review)

BACKGROUND: Reconstruction of extensive defects to bone tissue is one of the important problems of orthopedics and traumatology. Especially in acuteis, the problem is associated with the restoration of bone tissue in conditions of its deficiency in pediatric patients.&#x0D; AIM: The aim of the study is to analyze modern methods of surgical treatment in children with extensive bone tissue injuries based on the published literature.&#x0D; MATERIALS AND METHODS: Our report presents a review of the literature of methods of surgical treatment of extensive bone defects. The literature search was carried out in several databases such as PubMed, ScienceDirect, E-library, GoogleScholar for the period from 2005 to 2020, using the keywords given below. As a result of the search, 105 foreign and 37 domestic sources were found. After exclusion, 56 articles were analyzed, all presented works were published in the last 15 years.&#x0D; RESULTS: The gold standard for replacing bone defects is still the use of autografts, including the use of technologies on a vascular pedicle. Various types of xenografts and allografts of bone tissue are increasingly being replaced by various kinds of synthetic implants.&#x0D; CONCLUSIONS: To date, there is no single generally accepted standard for the surgical treatment of extensive bone defects. The option of surgical treatment of extensive bone tissue defects using tissue-engineered bone implants with axial blood supply seems to be extremely interesting and promising.

Free Fibula Flap Reconstruction for Extensive Hand Tissue Defect Due to a Gunshot Wound : A Case Report

Free Fibula Flap Reconstruction for Extensive Hand Tissue Defect Due to a Gunshot Wound : A Case Report

Coverage of Severely Burn Injured Knee with Supercharged Reverse ALT Flap: Avoiding Limb Amputation

Primary skin and soft tissue reconstruction of large defects around the knee may be a challenge for the plastic surgeon. Fasciocutaneous flaps play an essential role in achieving functional and aesthetic restoration. We present the surgical reconstruction of an extensive 3rd degree burn injury with knee joint capsule and ligaments involvement in a 51-year-old patient. Devitalized structures were firstly debrided and a supercharged reverse anterolateral thigh (RALT) flap was used to cover the resultant tissue defect. The ALT fascia was employed to reconstruct the damaged joint capsule in order to restore articular function. The supercharged RALT flap has a greater blood supply compared with standard flaps and enables us to use larger flaps to reconstruct extensive knee and proximal leg tissue defects.

Forequarter Amputation and Reconstructive Options.

This study aimed to present the results of a series of forequarter amputations (FQAs) and to evaluate the reconstructive methods used. Although FQA has become a rare procedure in the era of limb-sparing treatment of extremity malignancies, it is a useful option when resection of a shoulder girdle or proximal upper extremity tumor cannot be performed so as to retain a functional limb. Thirty-four patients were treated with FQA in 1989 to 2017. Various reconstructive techniques were used, including free fillet flaps from the amputated extremity. All patients presented with intractable symptoms such as severe pain, motor or sensory deficit, or limb edema. Seventeen patients were treated with palliative intent. Chest wall resection was performed in 9 patients. Free flap reconstruction was necessary for 15 patients, with 11 free flaps harvested from the amputated extremity. There was no operative mortality, and no free flaps were lost. In curatively treated patients, estimated 5-year disease-specific survival was 60%. Median survival in the palliatively treated group was 13 months (1-35 months). Limb-sparing treatment is preferable for most shoulder girdle and proximal upper extremity tumors. Sometimes, FQA is the only option enabling curative treatment. In palliative indications, considerable disease-free intervals and relief from disabling symptoms can be achieved. The extensive tissue defects caused by extended FQA can be safely and reliably reconstructed by means of free flaps, preferably harvested from the amputated extremity.

Перекрестная пересадка комбинированного лицевого трансплантата в эксперименте на биообъектах

Facial graft transplantation remains the operation of choice for patients with extensive tissue defects in the maxillofacial region. This study aimed to set up an experiment on biological objects, develop and test a combined facial graft cross-transplantation technique, select the anesthetic aid allowing to reduce the risks of perioperative complications, improve survivability of the subjects by reducing the duration of surgical intervention, develop a postoperative therapy and rehabilitation protocol, assess detection of an acute rejection reaction and develop the immunosuppressive therapy protocol. We conducted three series of facial graft transplantation surgeries on 26 minipigs and tested the typical component combinations and flap designs. At all stages of the experiment, we managed to have the subjects surviving for over 30 days without disrupting their vital functions. The immunosuppression procedure was developed and tested. The chosen technique allows transplanting two grafts within a single surgery on one pair.

Oblique Paraumbilical Perforator (OPUP) Flap: A Reliable Reconstructive Option in Massive Soft Tissue Defect of the Elbow

ABSTRACT Objectives: The upper extremity is an important functional unit and is frequently exposed to trauma. Large soft tissue defects in the upper extremities require reconstruction with reliable tissues with maximum functional and aesthetic results.We aimed to present a reconstruction a massive soft tissue defect of elbow with oblique paraumbilical perforator flap in a multitrauma patient. Methods: A 26 year-old female patient was admitted as a result of an in-vehicle traffic accident. The patient had cerebral contusion, lung contusion, humerus fracture, tibia fracture, large dermal abrasions in the trunk,extensive tissue defect including scalp, wrist, elbow and proximal forearm. After reduction of fractures,ulnar nerve was reconstructed with sural nerve graft. 22 x 17 cm sized massive soft tissue defect of the elbow was. Results: Based on two deep inferior epigastric artery perforators the OPUP flap was raised in suprafascial fashion. The flap was divided on the 22nd day. No complications observed postoperatively. Conclusion:The OPUP flap is a versatile and reliable flap; hence it can be used as a salvage option for massive upper extremity defects around the elbow especially when other reconstructive methods are not possible. Keywords: elbow; perforator flap; upper extremity

Musculocutaneous grafting in the treatment of irradiation-induced chest osteomyelitis

To report our own experience of one-stage surgical treatment of irradiation-induced osteomyelitis as a complication of radiotherapy for breast cancer (BC). The study included 25 patients with irradiation-induced chest osteomyelitis after previous radiotherapy for breast cancer. All patients were examined according to the same protocol. One-stage surgery with full-thickness resection of affected tissues and plastic closure of the wound was performed depending on localization of lesion and availability of plastic material. Follow-up period ranged from 18 to 110 months (median 48 (19; 52) months). Complications were assessed according to Clavien-Dindo classification. Complications followed by antibacterial therapy and/or local treatment were observed in 8 (32%) out of 25 patients (95% CI 11.5-43.4). Marginal necrosis of musculoskeletal flap was registered in 4 (16%) patients. One (4%) patient required redo thoracomyoplasty after excision of necrotic tissues of musculocutaneous flap due to extensive tissue defect. Total necrosis of musculocutaneous flap was not noted. There were no fatal outcomes. Mean length of hospital-stay was 13 (10; 27) days in the group of musculocutaneous flap from latissimus dorsi muscle and 11 days (7; 24) in the group of rectus abdominis muscle. Good and satisfactory treatment outcomes after one-stage surgical treatment were achieved in 24 (96%) out of 25 patients (95% CI: 75-97.8). Irradiation-induced chest osteomyelitis is still actual problem despite an improvement of modern medical equipment and accumulation of experience in radiotherapy. Surgery is preferable method of treatment. Comprehensive examination including contrast-enhanced chest CT with 3D reconstruction and Doppler ultrasound of vascular pedicle is valuable to determine type of resection and plastic technique. Simultaneous approach with resection and plastic closure of the wound is preferred for irradiation-induced chest osteomyelitis if sufficient amount of plastic material is available and contraindications for reconstructive surgery are absent.

Reconstruction of a full-thickness buccal defect with anterolateral thigh flap – case report

Extensive tissue defects resulting from tumor resection within the head and neck require simultaneous reconstruction. One of the most commonly used free flaps in reconstruction oral cavity is the free anterolateral thigh flap. A case of a 57-year-old woman with squamous cell carcinoma of the cheek has been presented, in which the reconstruction of the full thickness of the cheek with a folded free anterolateral thigh flap has been performed. The authors provide treatment methods and the possibility of using ALT flap.

Quality of life and reconstructive surgery efforts in severe hand injuries.

Introduction:Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process.Materials and methods:In this retrospective study, we evaluated patients with severe hand injuries from 2013 to 2016 who had completed surgical and non-surgical treatment. Measures included total period of therapy (TPT) in days, total duration of operations including anesthesia (TOA), total duration of all operations (TO), and total number of operations (TNO). We also determined total inpatient stay (TIS), total number of clinic presentations with interventions (TNPI), initial hand injury severity score (iHISS), and inpatient proceeds (IPP) in Euros (€). Correlation was assessed between iHISS and TOA, TNO, and TIS. Finally, these patients were reexamined in a follow-up inquiry and the life quality was assessed with the five-level version of the EuroQol five-dimensional (EQ-5D) descriptive system (EQ-5D-5L).Results:We analyzed 12 patients with an average age of 44 years (min. 24 years, max. 75 years). Patients receiving reconstructive surgery experienced median (n{rm{tilde x}}n) TPT of 175 days [interquartile range (IQR), 51–499], TOA of 13 h (IQR, 6–37), TO of 9 h (IQR, 4–25), and TNO of 5 (IQR, 3–11). Further, the patients’ median TIS was 22 days (IQR, 9–86), TNPI was 4 (IQR, 2–8), and iHISS was 77 (IQR, 44–162). The median IPP was 14.595 € (IQR, 5.541–33.709 €). IHISS was positively correlated with Pearson’s r for TIS (0.817), TOA (0.857), and TNO (0.871). The EQ-5D-5L index value resulted in a high level of life quality with a median of 0.898 (min. 0.8, max. 1).Conclusion:Severe hand injuries are related to high efforts for surgical and functional reconstructions, which result in high quality of life measured with the EQ-5D-5L assessment. However, for a defined collective of patients, myoelectric prosthetic functional replacement should be considered. Further studies are necessary to examine functional outcomes and quality of life after bionic prosthetic replacement. Also, a bionic reconstruction score to define hard criteria for taking an acute treatment decision is necessary.

An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report

BackgroundThe surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome.Case presentationIn this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence.ConclusionsIt is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.