Abstract
Extensive composite mandibulectomy is defined as en bloc resection of inner mucosa, mandible, soft tissue, and outer skin, which inevitably leads to a through-and-through oro-mandibular defect. Due to the loss of large tissue volume and multiple tissue components, reconstruction is still a challenging task for plastic surgeons. Several reconstructive options have been introduced and can be simply classified as the use of a soft tissue flap in combination with a reconstruction plate or a bone graft, and the use of a bone flap in combination with a sophisticated osteocutaneous design or another soft tissue flap. The use of soft tissue flaps can not only replenish the large loss of tissue volume but also facilitate future auxiliary procedures. The use of bone flaps will prevent the late complications caused by the use of reconstruction plates or bone grafts. Taken together, it is unequaled to accomplish an oro-mandibular reconstruction with one bone flap and one soft tissue flap. As we all know, the classical combination is one fibula osteocutaneous flap for mandibular reconstruction and inner lining, and one anterolateral thigh fasciocutaneous flap for soft tissue restoration and outer coverage. However, the main disadvantage of this one-stage double free flap reconstruction is the lengthy operative time, especially in an era of work hour restrictions. By optimizing the surgical strategy of double free flap reconstruction using the anterolateral thigh flap and fibula flap, we completed the operation within 4 hours after the extensive composite mandibulectomy.