Latissimus-serratus-rib free flap for oromandibular and maxillary reconstruction

OBJECTIVE: To review complications and outcomes associated with latissimus-serratus-rib free flap oromandibular and midface reconstruction. DESIGN: Retrospective medical record review. SETTING: Two academic tertiary care medical centers. PATIENTS: Twenty-eight patients with segmental resection of the mandible and 1 patient with combined resection of the mandible and maxilla after excision of neoplasms of the oral cavity, who were believed to be poor candidates for fibula free flap reconstruction, were identified. INTERVENTIONS: Twenty-seven latissimus-serratus-rib osteomusculocutaneous free flap reconstructions and 2 serratus-rib osteomuscular free flap reconstructions were performed. MAIN OUTCOME MEASURES: The outcome of microvascular free tissue transfer as well as short- and long-term complications were recorded. RESULTS: There were no perioperative free flap failures. Delayed partial rib graft resorption occurred in 1 patient 33 months after free flap transfer for maxillary reconstruction. Among 28 cases of mandibular reconstruction, 1 case of bone graft nonunion was noted after a postoperative period of 57 months. All other cases achieved successful restoration of mandibular continuity. Donor site morbidity was well-tolerated in all patients. CONCLUSION: Latissimus-serratus-rib osteomusculocutaneous free flaps are effective for reconstruction of composite defects of the mandible in patients who are not candidates for more commonly used vascularized bone-containing free flaps.